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" If prudery is shocked at my poetry of truth, — the only pure 

poetry, — it is of no consequence to me. I do not ask 

the advice of those shame-Saces, who would be 

chaster than nature and -'.purer than God." 



Price of this volume, bound in cloth . , $1.25 

" " " " paper 1.00 

Sent free, by mail, on receipt of price, by 

M. CHARLES & CO., PUBLISHERS, 
87 Hanover Street, Boston. 



THE 



PHYSIOLOGY OP WOMAN 

AND 

'7/0 HER DISEASES 

FROM INFANCY TO OLD AGE : 



INCLUDING ALL THOSE OF HER CRITICAL PERIODS, PREGNANC1 

AND CHILDBIRTH J THEIR CAUSES, SYMPTOMS, AND 

APPROPRIATE TREATMENT, WITH HYGIENIC 

RULES FOR THEIR PREVENTION, 

AND FOR THE 

PRESERVATION OF FEMALE HEALTH: 

ALSO, THE MANAGEMENT OF 

PREGNANT AND PARTURIENT WOMEN, 

BY WHICH THEIR PAINS AND PERILS MAY BE GREATLY OBVIATED. 
TO WHICH IS ADDED, 

% ($n?atis£ on Momanliood and Jpanhood, 

LOVE, MARRIAGE, AND HEREDITARY DESCENT: 

BEING THE MOST APPROVED VIEWS OF MODERN TIMES, 

ADAPTED TO THE INSTRUCTION OF FEMALES 

AND PROFESSIONAL READING. 

IN THREE BOOKS — COMPLETE IN ONE VOLUME. 



BY C. MORRILL, M.D. 



Author of Sundry Medical Essays, Lectures on Popular Physiology, etc. 




FIZFTH BDITIOWaC 

.BOSTON: 
M. CHARLES & COMPANY, 

87 Hanover Street. 
1868. 



Entered according to Act of Congress, on the twenty-ninth day of May 
in the year 1868, by 

M. CHARLES & CO., 

In the Clerk's Office of the District Court of the United States, for the 
District of Massachusetts, 



TO 

THE WOMEX OF AMERICA, 

AND TO 

ALL OTHERS 

WHO FEEL INTERESTED IN THE WELFARE AND 
IMPROVEMENT OF OUR RACE, 



Khis -SHta* 



IS RESPECTFULLY INSCRIBED BY 



THE AUTHOR. 



FALSE DELICACY AND NOTIONS ON ANATOMY AND 
PHYSIOLOGY. 

Some persons think it wrong to exhibit plates and models illustrating 
different partsof the female, particularly to youth. But this is an im- 
proper view of the subject : it is the result of false delicacy, and arises 
from ignorauoe. The more we attempt to conceal from children or oth- 
ers, the greater is their curiosity, and the stronger their desire to gratify 
it unobserved. Such is the law of perverted nature. The best way is 
to inculcate no secrecy, by restricting a knowledge of any part of the 
system, but allow every part to be studied, and let children be taught 
very little reserve. It is not the most fastidious who are the most virtu 
oils, and we should suspect such, much sooner than others. It is only 
by an early study of physiology that the mind can be disenthralled from 
the false notions which are so common on these subjects. An excellent 
method to curb the veneral appetite, and to elevate and refine the char* 
acter is, to study well every part of the human system, and recognise 
the Divine Architect in its wonderful mechanism. "To the pure" 
says the apostle, " all things are ?ureu w ** I am glad the time has come," 
observed a sensible lady of Philadelphia, " when people are not 

iSHAMED OF GrOD B OWN WORK." — Beach, 



CONTENTS, 



FAOI 

Dedication, , „ 3 

False delicacy and notions on Anatomy and Physiology. . . 4 
INTRODUCTION. 

Woman, the companion of man — an object of the highest interest. 
One of the most essential objects of creation. — Her beauty 
and charms depend on her health. . 7 

The normal woman, the most beautiful object of creation. — Her 
influence an undying stimulus to man. Why she should pre- 
serve her loveliness. — Consequences of losing her health. . 8 

Perpetuation of the species the great end of woman's existence. 
She requires perfection of organization, and to be instructed. 
Ignorance the cause of her suffering. # 8-9 

Never intended that human life should be prematurely extin- 
guished — its prolongation depends on our own conduct — illus- 
trations of ignorance • . . . d 

Melancholy consequences of a want of knowledge concerning 

her own constitution 10-11 

Modes of imparting instruction — plan of this work — deficiencies 

of others 11-12 

Not intended that the female shall be her own physician ; impart- 
ing information the true way of suppressing quackery. . . 13 



BOOK I. 

THE PHYSIOLOGY OF WOMAN. AND HER DISEASES. 



PART I. 

ANATOMY OF ORGANS PECULIAR TO THE FEMALE. 

CHAPTER I. 

PECULIARITIES OF THE FEMALE SYSTEM. 

The organization of the female distinct from the male. . . 17 
Hermaphrodites. ... ... • • .18 

Peculiarities numerous. 18 

Muscular, Nervous, Circulatory and Gellular systems. « "9 



Vt CONTEXTS. 

»AOS 

The Tel vis— tvt of. . .20 

BImWcr, Vagina, Uterus- -tleftori pi ions o£ • . , . 7\ 
View of I ho organs ol the female Pelvis. • . » .S3 

Rectum, etc. t • . 23 

CHAPTER II. 

REPRODUCTIVE ORGANS. 

External genmtal organs— Mons Veneris, Labia Mnjora and 

Nymplue. . .2/ 

Clitoris Hymen. 25 

Internal genital organs — Fallopian Tubes. • ^6 

View of the Vagina and Uterus -Ovaria. • . . , 27 

Mammas or Breasts. ....... .28 

Sympathy between the Breasts and Uterus. • • « 29 



PART II. 

DISEASES OF THE EXTERNAL GENITAL ORGANS. 

CHAPTER I. 

DISEASES OF THE LABIA MAJOR A. 

Inflammation and swelling of . . • • , 9ft 

Abscesses of— Causes. Symptoms and Treatment. , • .21 

Encysted and Warty Tumors of. 31 

Growing together ofthe Labia — Treatment. ... • 32 



CHAPTER II. 

DISEASES OF THE KYMPI1JS. 
Enlargement — "Warts — Excoriation of— Treatment. • • • 32 



CHAPTER III. 

DISEASES OF THE CLITORIS. 
Cancer — Malformation — Enlargement of— Treatment. * . 33 



CHAPTER IV. 

IMPERFORATION AND TOO GREAT DENSITY OF THE HYMEN. 
Causes, Symptoms and Treatment. . ... .33 



CHAPTER V. 

INFLAMMATION OF THE VULVA. 

In children, producing Infantile Leucorrhea — Causes, Symptoms 

and Treatment . . 54 

la Adults .35 



CONTEXTS. VII 

PAGE 

CHAPTER VL 

PRURITUS, OR ITCIIIXG OF THE VULVA. 

Symptom*! Causes, and Treatment. ,..•.. • 36-6 

Other Ureases of the External organs, . «... 37 



PART III. 

PHYSIOLOGY OF THE INTERNAL GENITAL ORGANS MENSTRUA- 
TION NATURE TIME OF OCCURRENCE AND QUANTITY- 
IMPERFECT PUBERTY, WITH HYGIENIC RULES FOR ARRIVING 
AT HEALTHY MENSTRUATION. 

CHAPTER I. 

PHENOMENA OF THE PHYSIOLOGICAL AND MORAL CHANGES 
WHICH OCCUR DURING CHILDHOOD AND AT PUBERTY, WITH 
HYGIENIC RULES FOR THE NORMAL DEVELOPMENT. 

Worthy of our attentive meditation. .... .38 

Affections to which the infant is most liable — not to be lost sight 
of— Errors in rearing children. 33 

Sad picture of the result of such errors— Changes at the approach 
of Puberty. . * ...... .40 

Period of gentle pleasures — Expansion and elegance of the form 
at Womanhood. ......... 41 

Great changes throughout the whole economy — In her gestures, 
feelings, tastes, enjoyments, etc. — The sympathetic irradiations 
of the Uterus give rise to new desires. ... .42 

Causes which retard or hasten puberty 43 

Hygienic rules for the normal development of puberty — 
Dangers of ignorance among girls — The mothers duty to in- 
form them concerning the Menstrual discharge. . . . 43-4 

Vegetable Diet — Cooling Drinks — Bathing — Exercise — Walking, 
riding, frictions, etc .44 

Tardy appearance of the Menses — Remedies — Dangers of read- 
ing romances — The theatre — The fatal evii of Masturbation. 45 

Management of erotic exaltation — Of the cold and apathetic 46 

CHAPTER II. 

THE APPROACH OF MENSTRUATION. 

Definition — Early and late appearance. . , . .47 

Depends on the development of the constitution — Moral and 

physical changes. .48 

Duty of mothers to inform their daugnters — Symptoms of its 

approach. . . ... . . , . . . 49 

Troublesome symptoms — Time of contmnance. . . .50 



VIII CONTENTS. 

PAGE 

CHAPTER III. 

THE PHYSIOLOGY OF MENSTRUATION. 

Source of the Menses — Cause — Different opinions. . • . 51 

Cause to be found in the Ovaries. ...... 52 

Purpose of Menstruation • 53 

Changes produced in the Ovaria — Nature of the discharge — con- 
stitutional. .j .54 

Opinions of the Ancients. • . . • • . • • 55 

CHAPTER IV. 

TIME OF OCCURRENCE AND QUANTITY OF THE MENSTRUAL 

DISCHARGE HYGIENIC RULES FOR MENSTRUOUS WOMEN. 

Menstruation divides the life of the female into three periods. . 55 
Variation in the time of appearance. .... .56 

Influence of warm and cold climates. 57 

Quantity discharged. .58 

The health and beauty depend on the regularity of this discharge 

— Sad picture of obstructions .59 

Hygienic rules for menstrous women 59 

Cold — Napkins — Diet — Bleeding — Medicines — Clothing, etc. • 60 

CHAPTER V. 

IMPERFECT PUBERTY WITH THE CAUSES AND TREATMENT OF 

PRECOCIOUS MENSTRUATION. 

The Menstrual discharge constitutional 61 

Changes wrought in the organism. .62 

Causes which retard or precipitate Puberty — Masturbation. • 63 

Connection between precocious menstruation and scrofula. • 64 

General conclusions. ........ 65 

Treatment — constitutional vigor better than medicine — Exercise 

— «Food,etc 66-9 



CHAPTER VI. 

GENERAL HYGIENE FOR WOMEN, BY WHICH THEY MAY SECURE 

TO THEMSELVES HEALTH AND PERSONAL BEAUTY. 

Medicine as a developing and curative agent 69 

Obedience to the physiological laws necessary. • • .70 

1. Surrounding Circumstances — Air. • • • • • 71 
Odors — perfumes, etc., dangers of • 72 

2. Applicata — Clothing. 73 

Cleanliness — Bathing. . • . . . . . . . 74-5 

Cosmetics — Rouge — Dentifrices — Care of the Teeth — Hair — 

Depilatories 75-9 

3 Idgesta — Food — Drinks, etc. — Simple — highly seasoned food. 79-83 

4. Excerta — Excretion of the menses, -urine, sweat, etc. . 80-1 

5. Grsta — Exercise, late hours, sleep, rest, etc. • . . 81-3 

6. Percept a, passions, intellectual labors, etc. . • • 83-5 



CONTENTS. IX 

PAGE. 

PART IV... 

DISEASES OF THE INTERNAL GENITAL ORGANS DERANGED 

MENSTRUATION, WITH OTHER FUNCTIONAL DISORDERS AND 
ORGANIC DISEASES. 

SECTION L 

FUNCTIONAL DISORDERS. 

CHAPTER I. 

SYMPATHIES OF THE WOMB, WITH PRELIMINARY OBSERVA- 
TIONS UPON DISEASES OF THE INTERNAL ORGANS ; THEIR 

GENERAL CAUSES, DIAGNOSIS AND TREATMET. 

Sympathies of the Womb — Curious opinions of the Ancients. • 85-6 

With the Breasts— Stomach — Brain, etc S7-8 

Preliminary observations on diseases of the Uterine System — 

Functional— Organic. 88-90 

Changes which the Uterus and its Appendages undergo at the 
great epochs of female life — before Menstruation — during ges- 
tation . . . , , 00 

After delivery, in elderly women. ....... 91 

General Causes. . . . . • , • . . 94 

Diagnosis and Treatment 93-4 

CHAPTER II. 

SUPPRESSION OF MENSTRUATION AT PUBERTY, OR TARDY 

APPEARANCE OF THE MENSES FOUR DIVISIONS CAUSES 

SYMPTOMS AND TREATMENT. 

1. When there is little or no development of tJie female system at the 

age of puberty — Management . . . . . 95-6 

2. Wlten tliere are indications of development, which is but slowly 

taking place — Causes , ... 97 

Treatment. . . 9 . . . . . . 98-9 

3. Wlien this development is prevented by a cJironic affection oj 

some other pan —Treatment 100 

4 When t/ie most perfect development has taken place yet, the menses 
do not appear — Treatment. . . . . . . 100-1 

CHAPTER III. 

AMENORRHEA, OR SUPPRESSION OF THE MENSES, OR ITS 
INTERRUPTION AFTER HAVU^G BEEN ESTABLISHED — ACUTB 

AND CHRONIC CAUSES SYMPTOMS AND TREATMENT. 

Acute Sujrpression — Causes — Symptoms — Treatment * . 10*2-5 
Chronic Suppression — Causes — Symptoms. , % . . 106 

Treatment, medical and hygienic. , • . « • . .107-12 



X CONTENTS. 

PAGE, 

CHAPTER IV. 

TICARIOUS MENSTRUATION NATURE— CAUSES AND TREAT- 
MENT. 
Causes — Treatment. ....... .112-13 

CHAPTER V. 

MENORRHAGIA, OR EXCESSIVE MENSTRUATION TWO DIVI- 
SIONS CAUSES SYMPTOMS AND TREATMENT. 

First division — Symptoms — Causes. - 114-15 

Treatment. . . • ,116 

Second division — Symptoms — Causes 117-18 

Treatment, medical, hygienic. , , • . • « J. 19-20 



CHAPTER VI. 

DYSMENORRHEA, OR DIFFICULT AND PAINFUL MENSTRUATION 

SYMPTOMS CAUSES AND TREATMENT. 

Symptoms — Causes. ........ .121-22 

Treatment — during tlue attack and interval, .... .123-24 

Treatment of the mechanical species 124 



CHAPTER VII. 

BECLINE, OR CESSATION OF MENSTRUATION CONSTITUTIONAL 

EFFECTS TREATMENT WITH HYGIENIC RULES FOR WOMEN 

AT THIS PERIOD. 

The circumstances attending the decline of the menses adapted 
to excite our interest — Greater liability to menstrual irregu- 
larity 125 

The occurrence, of incapacity for child-bearing founded in the 

highest wisdom — Symptoms ofthe approach of. 126 

Illusions — Physical changes — in the Womb, Skin. Hair. Voice. . 121 

Moral changes — in the temper — Sensibility — Passions — Tranqui- 
lity of life afte/ the "change." 128 

False apprehensions cf danger from the supposition of vicious 
humors being retained — Fewer women die at this age than 
men — Liability to cancer. 129 

Temporary allections at this period — Treatment. . . . . 130 

Hygienic riles for women at the change of life — Quack 
^ health pills, etc. . , . . . . f . .131 

Exercise — Atmospheric vicisitudes — Sleep. . . . , . 132 

The passions — Love — Prospect of many happy days beyond this 

period 133 

Medicines— Constipation, laxatives, — Bathing, etc. , , .134-35 



CONTENTS. XI 

PAGE 

CHAPTER VIII. 

LEUCORRnCE" NATURE VARIETIES SYMPTOMS CAUSES 

TREATMENT. 

Definition — Synonymous with the whites — Nature of the dis- 
charge — Origination 135 

Lcucorrhea very prevalent — In children — Temperament most lia- 
ble. ....... 136 

Scat of the discharge, Uterus, Vagina- 137 

Circumstances under which it occurs. 137-3S 

Symptoms— Acute— Chronic. . 13S-40 

Causes— Local, cold, violence, quack medicines, abuse of venery, 

etc 140-11 

Constitutional causes — Temperament — Location, atmosphere, 
occupation— rHabits of life — Diet, etc.— Erotic reading — Vicious 

habits— " Drugging/' . 142-44 

Duration — Not contagious, , , 144 

Treatment — Acute stage . .145 

U J — Chronic — Preliminary care. ... . 146 

Diet— Exercise, etc. — Medicines — Cleanliness — Bathing, etc. .147-50 

CHAPTER IX. 

CHLOROSIS NATURE SYMPTOMS CAUSES AND TREATMENT. 

Definition— Nature— Seat. ' 150 

Symptoms — Peculiar paleness — Indigestion — Depraved appetite 

etc .150-02 

Cavses — Predisposing, temperament, privation and abuse of love, 

deranged menstruation, emotions, etc. . . . . lf>2 

General causes, bad situations, indigestible food, fatigue, etc. .153-04 

Treatment — Purgatives — Iodine — Iron — Vegetable tonics, etc. 

General hygiene. . • . • . ,151-56 

^^^^^^ • 

CHAPTER X. 

HYSTERIA NATURE SYMPTOMS CAUSES VARIETIES 

COMPLICATIONS TREATMENT MORAL AND PREVENTA- 
TIVE MANAGEMENT. 

Definition — Influence of the Uterus. . • . .157 

Seat — Various opinions — Uterine system — Period of life — Tem- 
perament. • . . . . . . .15S-59 

Symptoms — " Protean shapes" of the diseases — globes hystericus, 

etc., etc. ....... .159-60 

VARiEriES — Peritonitis— Pains in the side — Palsy — Cough — Affec- 
tions of the spine and joints, etc. . . . .161-65 

Complications— Catalepsy — Ecstasy — Animal magnetism, Tran- 
ces. ....... .165-67 

Causes— Predisposing, emotions, bad diet, abuse of stimulants, 

over-education, etc. ..... .1CS-G9 

Exciting causes, deranged menstruation, emotions, improper 

food, worms, odors, sounds, etc. . . . .169-72 



XII CONTESTS. 

PAGE, 

Treatment — During the paroxysm, medical and moral. . J 72-74 
Darir.g the interval— Medicine — Hygiene. . . .174-76 



CHAPTER XI. 

NYMPHOMANIA, OR FUROR UTERINUS — MATURE CAUSES 

SYMPTOMS AND TREATMENT. 

Definition— Seat. ...... .176-77 

Causes — Predisposing, excitement of the brain, voluptious read* 

ing and conversation, etc. - . . . .179 

Exciting causes — Masturbation, abuse of venery. . 179 

Symptoms — Encouraging proposals — Delirium, etc. .. .178-79 

Treatmeni — Hygienic — Medical . • . ,179-SG 



CHAPTER XII. 

HYSTERALGIA, OR IRRITABLE UTERUS SYMPTOMS— C*.#S£S 

AND TREATMENT. 

Definition — Attacks all temperaments. • 181 

Symptoms — Causes. ..... .181-83 

Treatment — To relieve the pain — to restore the health. • .182-83 
Irritable Vagina* •••••• 18& 



SECTION n. 
ORGANIC DISEASES. 

CHAPTER I. 

» 

INFLAMMATION OF THE UTERUS FALLOPIAN TUBES AND OVA- 
RIES ACUTE AND CHRONIC CAUSES SYMPTOMS TER- 
MINATIONS AND TREATMENT. 

Preliminary observations. .183-84 

Intlammation of the uterus — Acute — Causes — Symptoms. . 184 

Chronic form — Causes — Symptoms." . .185-86 

Terminations — Treatment .186-87 

Inflammation of the Fallopian tubes and Ovaria. • . J. 87-88 

CHAPTER II. 

SIMPLE ULCERATION OF THE NECK OF THE UTERUS— CAUSES 
SYMPTOMS AND TREATMENT. 

ilppearance through the Speculum — Causes— Symptoms — Diag- 
nosis. .188-89 

Treatment. ..,...••• .150 



CONTElfTS. XIII 

PAGE. 

CHAPTER III. 

PROLAPSUS OF THE UTERUS — NATURE— CAUSES SYMPTOMS 

AND TREATMENT. 

Preliminaiy observations on displacements. • • • , 191 
Definition — Different degrees of. . • • . . 1 92 

Causes — Relaxation of the pelvic muscles, pregnancy, ill-man- 
aged labors, improper diet, dress, etc. ..... J.93-94 

Symptoms — Pain in the loins, etc.— May be seen externally. .195-96 

Treatment — Result of neglect 197. 

Imperfect prolapse — Mode of reduction — Hygienic means for 

restoration 198 

Complete prolapse — Management — Pessaries — Mode of intro- 
duction — Hygiene ..... . 199-202 

CHAPTER IV. 

INVERSION OF THE UTERUS— -CAUSES SYMPTOMS AND 

TREATMENT. 

Description of 1 — Varieties. • 202 

Causes— Connected mostly with child-bearing. . . • . 203 
Symptoms — Sinking— Bleeding — Diagnosis from an examination 

per vaginam, . * . . . 203--4 

Treatment— Mode of reduction — After-management • . 204-6 

CHAPTER V. 

RETROVERSION AND ANTREVERSION OF THE UTERUS CAUSES 

SYMPTOMS AND TREATMENT. 

Causes — Over-distention of the bladder and rectum, etc. . . 207-8 
Symptoms — Pain in the loins, etc. — Mode of distinguishing the 

two affections. .208-10 

Treatment — Preliminary efforts — Modes of reduction — Hygienic 

management. ► , ,210-11 

CHAPTER VI. 

OTHER DISPLACEMENTS OF THE UTERUS, OVARIA, OF THE 
BLADDER AND URETHRA, OF THE VAGINA, AND OF THE REC- 
TUM CAUSES SYMPTOMS AND TREATMENT. 

Curvature — Causes — Symptoms and Treatment '*«.'■•• 212 
Inclination and obliquity of the Uterus. . . . # . 213 

Elevation and Immobility. . . , » ' • ' • • . 214 

Hernia of the Uterus. . 215 

Hernia and displacement of the Ovaria. . . . , . 216 

Displacement of the bladder 217 

Prolapsus of the mucous membrane of the urethra— Displace- 
ment of the intestines into the vagina. . . . . . 218 

Prolapsus of the vagina— Invagination of the vagina. , .219-20 



XIV CONTENTS. 

PAGE 

Prolapsus of the rectum, hemorrhoids, piles, costiveneness — 

Causes — Symptoms and Treatment. . . , • , 2*20 

Description of— External and internal piles. . . , . 221 

Causes — Costiveness, bad diet, etc., purgatives 221-22 

Symptoms— Prolapsus ofthe rectum— Piles. . .^ . .222-23 
Treatment — Mode of reducing tailing ofthe rectum — After-treat- 
ment-Piles, 223-21 

Hygienic treatment —Wholesome and unwholesome food. . 224 
Innutricious material necessary with our food. . . . 225 
Unbolted, wheat bread— Fruits — Natural drinks of mankind- 
Tea and coffee, etc., etc 220-27 



CHAPTER VII. 

UTERINE DROPSY CAUSES SYMPTOMS AND TREATMENT. 

Description of, etc. 227 

Causes— Symptoms and Treatment 228 

CHAPTER VIII. 

MOLES, HYDATIDS, ETC. OF THE UTERUS. 

Causes — Result of conception 230 

Symptoms — Treatment. * • • • 231 

CHAPTER IX. 

FIBROUS TUMORS OF THE UTERUS AND OVAR1A NATURE 

CAUSES SYMPTOMS AND TREATMENT. 

Nature of 1 -- Varieties , , • . 231 

Causes — Irritation. ..••%«••• 232 
Symptoms — Treatment. ....... .233-34 

Fibrous tumors of the Ovaria 234 



CHAPTER X. 

POLYPUS OF THE UTERUS CAUSES SYMPTOMS AND TREAT- 
MENT WITH OTHER MORBID COLLECTIONS IN THAT ORGAN. 

Description of— Causes. ...,»,.. 235 
Symptoms — Diagnosis. ..,..#. ,236-37 

Treatment — Different plans. , % 237 

Calculous or Stone. % • % . 233 
Osseous or cartilaginous formations — Physometra, or Uterine 
Tympanites, 239 

CHAPTER XI. 

CAULIFLOWER EXCRESSENCE OF THE UTERUS NATURE 

SYMPTOMS AND TREATMENT. 

Description of — Causes — Symptoms. , , • • • 240 
Treatment .241 



CONTENTS. XV 

PAGK 

CHAPTER XII. 

CORRODING ULCER OF THE UTERUS NATURE SYMPTOMS 

DIAGNOSIS AND TREATMENT. 

Description of— Symptoms. • , . • • , • • 24*4 
Treatment ,243 



CHAPTER XIII. 

CANCER OF THE UTERUS AND OVARIA NATURE CAUSES 

SYMTOMS AND TREATMENT. 

Description of — Time of occurrence. . . . , » 244 

Nature — Stages — Causes. . 245-46 

Symptoms — Pain — Hemorrhage — Discharge — Lamentable ter- 
mination. . . . .246-43 

Treatment — Scirrhus stage — Cancerous stage. • . .249 -51 

Cancer of the Ovaria, , • . 251 



CHAPTER XIV. 

CANCER OF THE BREAST CAUSES SYMPTOMS AND TREAT- 

MENT. 

Nature of— Causes. ..,..,, . 252 

Symptoms. . . 253 

Treatment — Preventative — Curative — Exposure of quackery — 

Palliative. 253-57 

Other Tumors of the Breast. , . 257 

CHAPTER XV. 

DISEASES OF THE OVARIA AND FALLOPIAN TUBES— ENCYSTED 

DROPSY CAUSES SYMPTOMS AND TREATMENT. 

Preliminary observations. 258 

Nature of— Encysted Dropsy — Causes. ... . 253 

Symptoms. 260 

Treatment— Medical - Hygienic— Tapping— Remarkable case of 260-61 
Conclusion of Book I — Women may avoid the diseases to which 
tiiev are incident fcv living according: to the physiological laws. 262 



TVI CONSENTS. 



BOOK II. 

THE PHYSIOLOGY AND DISEASES OF PREGNANCY AND 

CHILDBIRTH. 
View of the Foetal Circulation. .... 264 

Introductory remarks — Pregnancy a physiological not a diseased 
state. ....... .265-66 



SECTION 1. 

PHYSIOLOGY OF PREGNANCY 

CHAPTER I. 

HIGIENIC RULES FOR THE NORMAL UNION OF THE SEXES, 
WITH REMARKS ON VICIOUS CONFORMATIONS OF THE 
FEMALE GENITALS, WHICH PROHIBIT THE APPROACH OF 
THE SEXES. 

Marriage one of the chief objects ot the meditations of philoso- 
phers — Age at which it should be consumated — Opinions oi 
the Ancients — French laws, etc. . . . .267-68 

Sad consequences of premature marriages — Evils of the abuse 

of pleasures — Modes of remedying them. . . .269-70 

Deformities and diseases which render marriage impracticable — 

Mode of distinguishing them . . . .270-71 

CHAPTER II. 

VICIOUS OR ABNORMAL CONFORMATION OF THE FEMALE PEL- 
VIS, AND GENITAL APPARATUS CAUSES AND TREATMENT. 

Deformity of the Pelvis — Causes — Treatment. . . .271-73 

Occlusion and abnormal conformation of the external sexual 

organs — Union of the Labia — Causes — Treatment. . . 274 

Excessive development of the Nymphse — Unnatural growth of 

the Clitoris — Remarkable case—Treatment. . . . 275 

Imperforation of the Urethra. ..... 276 

Faulty conformation of the internal organs — Imperforate Vagina. 277 
Narrowness of the Vagina — Of the neck of the Uterus— Obstruc- 
tion of the Fallopian Tubes. ..... 278 

Absence and malformation of the internal organs — Womb — 

Vagina, etc. . . . . . , .278-79 



CHAPTER III. 

STERILITY AND IMPOTENCE CAUSES AND TREATMENT. 

Definitions. . ...... 280 

Causes — Diseases, malformations, climate, disparity of age, etc.2S0-83 
Treatment— Caution- Hygiene. f .284-85 



CONTENTS. . xvn 



CHAPTER IV. 

THE ORIGIN OF HUNAN LIFE CONCEPTION. 

The female arrives to a happy state — Love of offspring the purest 

happiness of which she is in possession. . .2S5-S6 

Definition of Conception — One of the most astonishing phenome- 
na of Nature — Numerous hypotheses of— Spermatists — Ovists 
Syngenesis — Epigenesis — Absorption — Positive theory. .2S6-S7 

Ten fundamental laws concerning generation — Three additional 

laws. ............. 388 

Recent theory. ....... 289 

Review of certain arguments in favor of conception taking place 
in the Womb. . • . . . . .259-90 



CHAPTER V. 

THE ORIGIN OF HUMAN LIFE PREGNANCY OR UTERO 

GESTATION. 

Descent of the egg into the "Womb — formation of the membranes. 

chorion, amnion — Afterbirth. .... .291-92 

Progressive development of the foetus — Eighth day — Twelfth — 
Twenty-first — Thirtieth — Six weeks- — Two months — Three — 
Four— "Five— Six— Seven—Eight— Nine. . . .292-93 

Progressive increase in the size of the Womb. . . ,293-94 

The placenta or after-birth — Umbilical cord — Deciduary mem- 
brane — Liquor amnii. . . . . . .294-9') 

Fcetal Circulation. . . . . . . 296 

View of the cniid hi irfero. ..... 297 

Enormous size of the gravid uterus — position of the child — Dura- 
tion of pregnancy — Least time in which the child is capable of 
surviving/ ". . . . . . .295-99 

Abnormal pregnancy — Extra Uterine pregnancy — Superfoeta- 

tion. ........ .299-390 

Mole pregnancy — Deformities — Monstrosity and Marks. . 301 

False pregnancy — Is it possible to procreate either sex at pleas- 
ure? ........ 305 



CHAPTER VI. 

THE SIGNS AND PHENOMENA OF PREGNANCY. 
Changes in the face. eyes. etc. ..... . 303 

Cessation of menstruation — Morning sickness — enlargement of 
the Breasts, areola, etc. — Salivation — Enlargement of the abdo- 
men— Of the uterus — Quickening— Beating of the foetal heart. 304 
The urine — Appetite— Moral condition — Extraordinary changes. 3U6 
Signs may decieve — Lamentable consequences. . . 300 

Diseases supervene and are suspended during pregnancy . 306 



rV in CONTENTS. 

BAGS 

CHAPTER VII. 

HYGIENE AND MANAGEMENT OF PREGNANT WOMEN. 
Atmosphere— Clothing, corsets— Bathing— Bleeding— Diet. . 307-8 

Caprices of appetite— Excretions 309 

Exercise— Moral management .310 

Longings — Care necessary. 311 

SECTION II. 
DISEASES OF PREGNANCY. 

Powerful sympathies called forth by pregnancy — Often take on a 

diseased appearance — Divisions. . . . • .312 

CHAPTER I. 

ABORTION OR MISCARRIAGE CAUSES SYMPTOMS AND 

TREATMENT. 

Definition — Frequency 312-13 

Causes— Predisposing, temperament, tight-lacing, affections of 

the uterus, etc. 313 

Exciting causes, emotions, violence, medicines, etc. , . 314 

Difficulty of producing it — Criminal attempts — Dangers of. .31 5-1 5 

Symptoms — Chills — Hemorrhage, etc. 316-17 

Treatment— Hygienic— Medical. .... .318-19 



CHAPTER II. 

DISORDERS OF THE CHYLOPOIETIC VISCERA OR THE DIGESTIVE 

FUNCTIONS CAUSES SYMPTOMS AND TREATMENT. 

Nausea and vomiting. * .319-20 

Salivation or Ptyalism. ...... . 320 

Odontalgia or Toothache — Capricious and Fastidious Appetite. 321 

Heartburn or cardialgia. ..,..,.. 322 
Difficulty of swallowing — Vomiting of blood — Jaundice — Cramp 

of the stomach and bowels, etc. ,..,.. 323 

Constipation or cpstiveness , • • • 324 

Diarrhoea, Dysentery and Tenesmus. . • . 325 

CHAPTER III. 

DISORDERS OF THE CIRCULATING SYSTEM CAUSES SYMPTOMS 

AND TREATMENT. 
Sanguine Plethora 321 

Palpitation of the Heart— Syncope or Fainting. . 327 23 



CONTENTS. XIX 

PAGE. 

CHAPTER IV. 

DISORDERS OF THE RESPIRATORY ORGANS CAUSES SYMP- 
TOMS AND TREATMENT. 

Dyspnoea or Difficulty of Breathing — Cough 329-30 

Hemoptysis or spitting of Blood, and Epistaxis or Bleeding from 
the nose. . . . . . ■ * • • • .330-31 



CHAPTER V. 

DISORDERS OF THE NERVOUS SYSTEM AND SENSES. 

Insomnia or Sleeplessness . 331 

Hypochondriasis or Despondency, and disorders of the Intelli- 
gence, Moral inclinations and affections, , . , 

Cephalalgia or Headache. 

Puerperal convulsions. . . . . . • 

Nervous affections of the Eyes and Ears. 



332-33 
334 

,335-36 
337 



CHAPTER VI. 

EISORDERS ARISING FROM MECHANICAL PRESSURE OR DIS- 
TENSION. 

Hemorrhoids or Piles • 338 

Incontinence of Urine — Disuria and retention of. . . . 339 

Varicose or Distended Veins. ...... . 310 

(Epama or Anasarca, and ascites, or dropsy during pregnancy, .341-42 



CHAPTER VII. 

DISEASES OF THE GENITAL ORGANS DURING PREGNANCY. 

Pruritus ofthe Vulva — QEdema of the Labia — Inflammation and 

Rheumatism of the Uterus — Menstruation during Pregnancy.343-44 



PART II. 

THE PHYSIOLOGY AND DISEASES OF CHILDBIRTH. 



. SECTION I. 
PHYSIOLOGY OF CHILDBIRTH. 

Definition — The birth of man 345 

CHAPTER I. 

CAUSES OF LABOR. 
Opinions of Hippocrates and the Ancients— Periodicity of all the 
uterine functions — Efficient cause — Contractions ofthe uterus 
—Power of the will. 345-47 



XX 



CONTENTS. 



CHAPTER II. 



PAO* 



THE MECHANISM AND PHENOMENA OF SPONTANEOUS OR 

NATURAL LABOR. 
Definitions— Presentations— Requisites lor a natural labor— Pro- 



portion of! 

Mechanism of labor — Divided into stages — Preliminary signs. 
First stage — Phenomena of— Second stage. 
Third stage — Duration of labor, etc., etc. • • 

Labor pains. . 

Dilatation of the passages. 

Discharge of glairy mucus — Bag of waters. . • 



34743 
349 

350-51 

352-53 
353 
354 

,354-55 



CHAPTER III. 

IS PAIN IN CIIILEBIRTH A MORBID SYMPTOM ? 

A question of great moment — Facility of labor in the African 

women — Indian — Greenland — Perversion of our nature. .35S-&3 

Facility of labor in animals — Is the art of the accoucher necessa- 
ry ? — Illustrations, etc., etc. • 357-58 



CHAPTER IV. 

HYGIENE AND MANAGEMENT OF WOMEN IN CHILDBIRTH. 

Very little to do in a natwal labor — Danger of interference- 
Hygienic management — Room — Food and drinks. . .359-60 
Excretions — Moral state--Lying-in bed, etc. . . .361 62 
Touching the woman — Diagnosis. .... • 362 
Conduct of the woman — Conduct of the attendant. . . . 363 
Receiving the child — Separating the child. ... . 364 
Delivery of the afterbirth — Management of the child when it 

does not breathe — Tumors of the scalp—Bleeding of the cord.365-66 



CHAPTER V. 

MANAGEMENT OF DIFFICULT LABOR. 

Description of— Causes. . . S67 

Treatment — Time and patience, ergot of rye, etc. . . .367-68 
Rigidity of the passages — Toughness and weakness of the mem- 
branes — Obliquity of the uterus — Retained placenta— Hem- 
orrhage or bleeding — Convulsions .368-70 

Powerless or Instrumental labor. . 370 



CONTENTS. XXI 



SECTION II. 
DISEASES OF CHILDBIRTH. 

CHAPTER I. 

CONDITION OF THE PATIENT AFTER DELIVERY MANAGEMENT 

OF WOMEN IN CHILDBIRTH, WITH VARIATIONS FROM ORDI- 
NARY CONVALESCENCE. 
Changes in the general system— Uterus — Vagina — Abdomen — 

After-pains — Lochia, or cleansings. .... .371-72 

Management ol'ihc woman — The room, posture, washing, bed- 
clothes — Breasts Die: — Exertion, etc. . . . .372-74 

Variations from ordinary convalescence — Nervous shock — The 

pulse — Uterus — Lochia- Milk fever — Lacerations, Infiltations.374-76 

CHAPTER II. 

PUERPERAL FEVER, INCLUDING PERITONITIS, UTERINE AND 
CRURAL PHLEBITIS CAUSES SYMPTOMS AND TREATMENT. 

Description — Causes — Sporadic form — Epidenic. . • .377-78 

Symptoms 378-79 

Treatment. 379-80 



CHAPTER III. 

PHLEGMASIA DOLENS OR MILK-LEG CAUSES SYMPTOMS AND 

TREATMENT. 
Description — Causes — Symptoms — Treatment. . • .381-82 



CHAPTER IV. 

SORE NIPPLES SCANTY AND PROFUSE SECRETION OF MILK 

MILK CONSUMPTION RETENTION AND ALTERATION OF THE 

MILK. 

Treatment of sore nipples — Exuberance of milk. • • .382-83 

Milk consumption. ......... 3S3 

Retention of the milk — Alterations of • • • • 334 



CHAPTER V. 

INFLAMMATION AND ARSCESS OF THE BREASTS CAUSES- 
SYMPTOMS AND TREATMENT. 

Causes — Symptoms. • 385 

Treatment — Preventative — Remedial. • , . • • 3S6 



XXII CONTENTS. 

PARTIII. 

INFANCY. 

CHAPTER I. 

IN WHAT MANNER THE CHILD MAY BE INFLUENCED BEFORE 
ITS BIRTH BY HEREDITARY CAUSES. 

The child before its birth influenced by the same causes which 
affect the mother — Diseases transmissible— By the father — By 
the mother — Modes of obviating these evils. **• • • .387-89 



CHAPTER II. 

INFLUENCE OF CERTAIN CONDITIONS IN THE MOTHER ON THE 
HEALTH AND CHARACTER OF HER OFFSPRING DURING PREG- 
NANCY. 

The mother's mark — Causes, which, acting upon her, will affect - 
her offspring — Interesting examples of. ... .389-90 

Direct relation between the mother and her child — Longings- 
Customs of the ancient Greeks for affecting favorably their 
children unborn. . . • . . i 391 

Directions for the mother — Hygiene. • • . - , .392-93 

CHAPTER III. 

HYGIENE AND MANAGEMENT OF INFANCY AND CHILDHOOD. 
The infant wisely denied the power of action. • . ♦ 393 

Clothing 394 

Food — Drink — Appearance of the teeth — Weaning. . .395-96 

Exercise— Air— Sleep—Bathing — Intellectual and moral train ing.396-98 
Conclusion — The laws of health fixed and never varying — Fe- 
males may hope to ascertain them and avoid most of the dis- 
eases to which they are incident. . , 399 



CONTENTS. XXIII 

BOOK III. 

ELEMENTS OF WOMANHOOD AND MANHOOD— LOVE 
MARRIAGE, AND HEREDITARY TRANSMISSION. 

CHAPTER I. 

ELEMENTS OF REPRODUCTION IN THE SEXES — WOMANHOOD — MAN- 
HOOD. 

PAGE 

Elements of Reproduction — Object of Sexual Distinction- 
Knowledge Required . . 403-4 

Sexual Elements — Formation of the Soul and Body . . 404 

Do not waste the Sexual Element — Solitary Indulgences . 405 
Evil of— Sad effects of Sexual Abuse 406-407 



CHAPTER IL 

LOVE AND MARRIAGE. 

The Family rests upon Love — Love, the natural aim of 

Woman — Rescue the Woman 407 

She will rescue you — Marriage less expensive than living 

single — A wife, a fortune 408 

Menstruation — Cause — Purity of— Knowledge required . 409 

Should be acquainted with each other — Love ; Passion — 

Sexual Instinct . . 410-11 

Incapacity must be known 411 

Oneness Required — Initiate the Daughter — Dutv of the Hus- 
band . \ 412 

Create your Wife — Love, a necessity in Woman— Confide in 

each other — She loves but one 413 

Love not in a crowd — Woman, an invalid . . . . 414 

Time of Conception — Period of Barrenness — Time of Mar- 
riage — Nobility of Love — Effect of Variety .... 414 

The wife Renews the Man ■ 415 

Adultery of the Woman — Fearful consequences of — Respon- 
sibility of Woman — Her Bosom, our Sanctuary . . . 415 



CHAPTER m. 

PARENTAGE — HEREDITARY TRANSMISSIONS, 

Heroes born of the most exalted Love — Union of Opposite 
Elements . . . 416 

Union of the Same Elements— Marriage of Relatives — Cross- 
ing of Qualities 416-18 

The Husband's Duty — Period of Barrenness . . . 418 

Fecundation extends long into the future, and transforms 

woman in a lasting manner 419 



XXIV CONTENTS. 

PAGE 

Hereditarj' Tendency to Diseases 419-20 

Inheritance may descend from either or both Parents . 420-21 

Venereal Diseases Transmissible 421-22 

Consumption and many other diseases Transmitted . . 422 

Influence before Birth 422-23 

The child of Love 423 

Time of Sensuous Intercourse 423 

Retain the Sexual Element 423 

Conduct of the Parents 424 

Acquired Diseases Transmitted 424-25 

Druukenness — Sexual Abuse — Solitary Sexual Abuse . 425-26 

Sexual Abuse during Pregnancy — Effect of Abortion . . 426 
Mental Conditions during Pregnancy — Effects of Lactation — 

Alcoholic Spirits — Anger and Terror .... 426-427 

Tranquillity Required-— Substitutes ..... 427-28 

Importance of the foregoing facts 428 

Disease an Effect — An evil to be prevented .... 428 
Physicians should be Clergymen, or Clergymen, Physicians 428-29 
The True Physician 429 



DIETETIC PREPARATIONS AND ADDITIONAL FORMS 
OF PRESCRIPTION. 

Barley-Water — Rice-Water — Vegetable soup — Panada — In- 
dian gruel — Mutton, chicken, veal, and beef broth — Beef 
and chicken tea — Tapioca — Arrowroot and sago — Wine 
whey — Caive's feet jelly — Tapioca, sago, and rice gruel . 431-32 

Forms of Prescriptions 432-33 



INTRODUCTION, 



Feeble and sensitive at birth, remarks LTsere, and destine*. 
by nature to give us existence and to preserve us afterwards, by 
means of her tender and watchful care, woman, the most faith- 
ful companion of man, may be regarded as the very comple- 
ment of the benefits bestowed upon us by the Divine Being; 
as an object fitted to excite our highest interest, and presenting 
to the philosopher, as well as to the physician, a vast field of 
contemplation. 

We have but to reflect a moment upon her social condition, 
in order to observe that the female is one of the most essential 
objects of creation : — that man without the influence of her 
charms would become a degenerate creature, and the world 
made desolate. The value of her influence, of course, much 
depends upon the perfection of her organization, physical and 
mental, on the refinement and elevation of her character, and 
on the delicacy and proper direction of her charming loveliness. 
Where health is not maintained, beauty soon disappears, and 
charms are lost ; indeed, health or perfection of physical devel- 
opment in the female, is almost synonymous with beauty and 
everything that is charming in her character: they are both 
found associated. 

The normal woman, as she came from the hand of the 
Creator is the most beautiful object of creation ; upon her frame 
is traced the most exquisite lines of grace, the resplendence o: 
which, has always formed a halo of angelic perfection, a sub- 
ject for the song of the poet, the fancy of the painter, and the 
skill of the sculptor. The constitution of the female mind and" 
character, widely differs from the male ; and it is impossible, 
in this state of existence, for the sexes perfectly to compre- 
hend each other; — thus, each is eminently constituted to divert 
the other. It is the love of woman — her attractive charms, 
which act as an undying stimulus to man, for "weal or woe,' 7 
in all his efforts — in his toils, his dangers and his privations ; 
by these is the student, pale and wasted by midnight study, 
cheered and comforted ; by these is the mariner sustained in 
his perilous voyages across the stormy, trackless deep; 
by these, also, is the soldier inspired with courage to face the 
cannon's mouth ; in fine, it is the charming loveliness of woman, 



8 INTRODUCTION. 

which sustains man in innumerable sacrifices and employments 
For the purpose of courting her favor, he lays at her feet the 
fruit of his toils, and finds in her acceptance and smiles, his 
happiest reward. Therefore, as the influence of woman is 
great, and effected through her charms, it becomes her duty to 
herself, to her family, and to the world to preserve her health, 
upon which the reality of her beauty depends. 

There are other and more important reasons why woman 
should preserve the charms of her own loveliness, or in other 
words her health. By losing it, she not only makes a wreck 
of her own expectations and happiness, but as a daughter, 
her premature death may fill the bosoms of her parents with 
never-ending sorrow. When she comes, according to the 
intention of nature, to fulfil the duties of a wife, she may 
reduce to despair her husband, her house to indigence, and 
convert to a sick-bed, what should have been one of comfort. 
The most important relation of her social condition remains 
yet to be told : an awful responsibility is attached to the title 
of " mother;" the healthy constitution of her offspring par* 
ticularly depends on the good health of the mother. Upon 
the originally healthy organization of the child, also, will very 
much depend the success of a well directed course of physi- 
cal education in after life. Confirmed ill health in the mother 
is sure to entail debility or disease on her offspring. A little 
timely knowledge might very often, to say the least, obviate 
these sad and afflicting results. 

The greatest end and object of woman's existence is, evi- 
dently, to perpetuate the species. The fatigue and anxiety of 
childbirth and nursing, the responsibility of educating her chil- 
dren, require, for their due performance, besides perfection of 
physical organization, qualities both rare and estimable, and 
an endurance of fatigue, as well as a submission to privations, 
which nothing renders supportable, but the love of offspring 
which a kind Providence has so deeply implanted in the nature 
of the female. But how can a vigorous woman even fulfill 
these important duties unless she be instructed % We are told 
by some that nature is to guide her! Such do not reflect that 
in her present social condition, she is subjected to an artificial 
mode of existence — a state that is continually opposing the 
native dispositions of the animal economy; but such is the 
case, and we must be satisfied, until some change is wrought, 
•vith seeking by the aid of philosophy for artificial substitutes, 
which harmonize with the nature of the female constitution. 
It is not too much to aver, that it is mainly owing to igno- 
rance of her own constitution, that woman in passing through 
her critical periods, or while fulfilling the endearing duties of 
the great end of her existence so often falls a premature victim 
to some of the numerous ills that beset her. 



INTRODUCTION. 9 

It was never intended by a bountiful Deity that human life 
should be prematurely cut off, or extinguished at its very 
dawn. That its prolongation depends on our own conduct anil 
management, is proved by the following circumstance : We 
frequently observe the feeble and delicate cluld, with proper 
care, become healthy and vigorous ; while the robust and heal- 
thy infant, under unfavorable circumstances, becomes enfee- 
bled in health, and unfit for the contingencies of life. 

It is quite uncommon to meet with a mother, who, before 
becoming such, had received the least instruction concerning 
the true object of those mysterious powers by which the species 
is reproduced : and, " will it be believed, that in more than 
one instance, in a class of life where fortune conferred its choic- 
est blessings, a young mother has learned, for the first time, 
from her physician, even when the pains of labor were upon 
her, that she was not to be subjected to a surgeon's knife, 
before she could be blessed with the darling object of her 
love? What does the feeling heart say to this? It can say 
but one thing: — truths which so nearly concern the welfare of 
those we love, can never be withheld without culpa- 
bility.'' Upon its mother the infant depends for that cherishing 
care which its delicate frame, at this period, so much requires. 
She it is according to the design of nature, who is to watch 
over its tender years, provide its nourishment, and attend to all 
its wants. But to what extent has her previous education fitted 
her for the correct discharge of these duties ? We find in the 
majority of instances, that she has contracted the marriage re- 
lation, and become a mother, without a suspicion of her defi- 
ciency in knowledge concerning the development birth, and 
bringing up of the new being which she is to cherish. It is 
true that she is deeply afflicted when she witnesses the suffer- 
ings of her babe, and bitterly laments her own inability to 
afford it relief. When it finally falls a victim to mismanage- 
ment, she piously submits to what she believes to be a dis- 
pensation of Providence; but which in reality is all owing to the 
want, on the part of the mother, of a little timely knowledge. 

The parent, remarks a medical writer, enters upon the im- 
portant charge entrusted to her care with less previous prepara- 
tion for its proper fulfilment, than if it were a plant or flower 
which God had committed to her management, instead of a 
living being in whose existence and happiness her whole soul 
is centered; for if a rare or curious flower be presented her, 
she will enquire minutely in regard to the best means of rear- 
ing it, and will act upon the information; but when a human 
being is confided to her care, the same person accepts of 
the trust, without asking a single question about the necessary 
treatment. 

B 



tO INTRODUCTION. 

"Who that has a heart to feel, or a judgment to weigh the 
consequences of those great and acknowledged errors of her 
physical training, can forbear to wish her enlightened on 
those immutable laws upon which her happiness so entirely de- 
pends] Who can suppress the sigh that involuntarily arises 
on beholding a family of attenuated offspring, too feeble to 
resist the encroachments of infantile disease, bending and 
withering beneath the slightest vicissitudes of atmospheric 
change, and constantly exciting the fears of an invalid mother 
for their very existence, whilst she herself, the unconscious 
cause of most of their ills, is scarce able, from exhaustion, to 
assert her position as their natural protector. 

" I envy not the heart of that man who can witness, without 
emotions deep-felt and sincere, and an instant conviction of his 
duty to the sufferer, the slow and insidious approach of dis- 
ease that is to deprive the helpless objects of a mothers love. 
I claim no sympathy from him who can day after day ap- 
proach the bed-side of the invalid, and console himself that 
she who has failed to receive at his hands the anticipated 
benefit, is beyond the reach of his skill from vices inherent in 
her organism. Is it his sole duty to dole out the pitiful pill 
or potion, that is absurdly expected to restore her to health? 
to make the rose revisit that sad cheek, blanched into prema- 
ture decay, from a total want of knowledge of the everlasting 
and immutable laws of her nature? Shall she fondly rely 
upon her chosen medical counsellor to lead her through the 
perilous paths of gestation and childbirth, when, from defi- 
cient education, she is often utterly ignorant of its natural 
progress? • Will he whose heart and head are better adapted 
to his high and responsible calling, from an absurd subjection 
to blind conventialism, oppose a sincere and honest effort for 
her instruction ? Look, for one moment, at those horrid and 
revolting outrages that have been committed in our midst, by 
those female fiends, the abortionists ! Could such things be, if 
women were properly instructed in the laws of their physical 
existence ? Would those registers of vice, that may emphat- 
ically be. called the dial-plates of infamy and corruption, dare 
to announce the occupations of these wretches, if the com- 
munity themselves were not in a state of moral apathy and 
heartlessness? 

" Which of our number, who values his character for 
truthfulness, dare to say, that he makes even the most ordinary 
prescription with more than a faint hope that it is understood, 
or will be carried out according to his wishes? It is well 
known to the physician, that very little reliance can be placed 
upon the best domestic aid our country affords; and that the 
prescription of the nurse or the patient (often of no mean de 



INTRODUCTION. 1 1 

gree of power) frequently accompanies, or precedes his own, 
Would this be so, if the patient possessed a guide for her con- 
duct, in the perilous situations in which she is often placed? 
Can it be improper to tell a rational mother, how to break to 
her child the end and object of those mysterious powers, 
which are to place her in a situation to fulfil the duties which 
her very instinct tells her she will be called upon to perform V 1 

It has been alleged by some physicians, that females re- 
quire no knowledge concerning their physical organization, 
because medical aid is always at hand to correct the evils of 
their ignorance. But what shall we say of the mere physic- 
giving physician, — he who sees nothing of the dangers 
which beset the female in her present condition ; who disre- 
gards the influence of a bad diet and air ; improper clothing ; 
want of exercise, proper ventilation and cleanliness ; and who 
expects in a day, by some paltry drug, to destroy the conse- 
quences of years of transgression, and that while the depressing 
cause still continues in action. A medical man is rarely con- 
sulted till the health is gone; and even if he were, intelligence 
on the part of the patient is needed, in order to second his 
efforts at restoration. Great evil not unfrequently results from 
the physician's prescription being misunderstood, untimely, or 
improperly administered. 

It must be conceded, then, that woman ought to be educated 
in the physiology and nature of her organization, and the dis- 
eases to which she is incident. Her own welfare requires 
this ) and not her own merely but the good of her offspring ; 
and in fine, the proper development of the physical and 
moral powers of our whole race depends upon the conduct of 
the female before marriage, during pregnancy, suckling, and 
afterwards. How is she to be instructed? We answer, by 
putting within her reach those truths concening her organ- 
ization which have been elicited by the patient investigations 
of the accomplished medical men, who have in every age of 
the world devoted their lives to these subjects, and to whom 
we are indebted for nearly all we know concerning the preven- 
tion and cure of disease. There are two ways by which this 
knowledge may be communicated; the first and most impoi- 
tant is, by putting into her hands works which shall be suffi- 
ciently extensive and perspicuous for the purpose ; the second 
is ? by frequent and free converse w T ith educated medical men. 

Our profession abounds in numerous valuable treatises 
upon the physiology and diseases of females, which contain 
information of the greatest moment to the sex. Why should it 
be withheld ? The author of this work makes no pretensions to 
originality; he has endeavored in presenting to the female a 
complete treatise on the Physiology of Woman axd her Dis- 



12 INTRODUCTION. 

eases, not to leave anything important unincluded; he has 
given the most approved views and treatment of modern times, 
and has made it an especial point to instruct females in the phy- 
siology of their system, and the mode of preventing disease, by 
dwelling at length on the causes and symptoms, and on special as 
well as general hygiene ; he has also labored, as far as con- 
sistent with a truthful exposition, to avoid shocking the preju- 
dices or delicacy of the reader. 

Within a few years, since' the author first contemplated the 
production of this work, a knowledge of her own system has 
been considered more indispensable as a part of the education 
of the female than formerly. Consequently, several books on 
this subject have made their appearance : some of these are of 
a character highly objectionable, and are purchased because 
there is a desire for such information as they profess to contain, 
and because their real character is not known ; — such are 
those "private medical companions" which are heralded 
through the country, by their empirical and mercenary origina- 
tors. Some others there are, by authors of respectability and 
science, and which might be read with profit; but in general, 
they are not sufficiently copious, treating only of a few dis- 
eases, without giving the treatment; or, they are not made suffi- 
ciently interesting, from being unembellished by topics of in- 
terest as well as of importance. Finally, others there are, of 
pocket size merely, but whose authors have the vanity to occu- 
. py some pages in giving the names of authors consulted in 
preparing their works ! ; and who also have the effrontery to 
say that they have sufficiently explained every female disease 
ever heard of! 

After thus alluding to the works of others, designed for the 
instruction of females, I will say nothing in favor of my own 
attempt ; in the body of the work itself, must be looked for 
its merits, and I leave it to stand or fall by its own worth. 

As I have before intimated, I make no pretensions to new dis- 
' coveries, but have in preparing this work freely consulted the 
most approved authors, whenever I believed the reader might 
be benefitted by so doing. The frequent acknowledgments 
and references to authors that I have had occasion to make 
throughout the volume, will, I hope, save me from any ac- 
cusation of illegitimate depredations. It will be seen that 
I have made free use of the able treatise of Colombat de 
LTsereon the Diseases of Females, translated by Dr. Meigs: 
to him I am much indebted for remarks on Hygiene, as well 
as the causes and symptoms of disease. The excellent works 
of Dewees, Churchill, Denman, Velpeau, Meigs, Dixon, Twee- 
die, Combe, Watson, and many others, have, also, been freely 
consulted. 



1MR0DUCTI0N. 13 

In giving the proper treatment of tire various affections to 
which the female is obnoxious, I do not wish to be under- 
stood as advocating the ideas of some, who believe that every 
one may become capable of doctoring himself. The domes- 
tic administration of medicine, as at preseut practiced, with- 
out a knowledge of the system, of the power of remedies, 
or of the diseases which they are designed to remove, is a 
great evil. There is at present such a thirst among all classes 
of community for all kinds of knowledge, that it is worse 
than useless to try to deprive them of it; the more physicians 
inveigh against these abuses, without imparting correct informa- 
tion, the more will " affectionate mothers and aunties' ; re- 
sort to dosing, or allow themselves to be influenced by quack- 
ery. On the contrary, the author believes, that if the commu- 
tvwere informed in regard to the proper treatment of disease, 
of the extensive acquirements necessary to constitute the edu- 
cated physician, and of the onerous duties he has to per- 
form, they would have a more just appreciation of his de- 
mands upon their patronage, repudiate quackery, and conse- 
quently receive more benefit from our noble and humane 
profession. 

The plan of our work will be seen from an examination of 
the table of contexts. After giving the anatomy of or- 
gans peculiar to the female, we have commenced with the 

PHENOMENA AND HYGIENE OF CHILDHOOD AND PUBERTY. Then 

we have treated of the physiology and all the diseases pecu- 
liar to every stage of Woman's existence. We have closed 

With the HYGIENE AND MANAGEMENT OF INFANCY thus making 

the whole subject complete by embracing every period of the 
life of the female. 

The intelligent woman will see the necessity of having in 
her confidence a capable physician; as it is impossible for 
her, as indeed it is for the physician, himself, to be a 
proper judge of her own diseased condition. 

To make our effort still more useful we have added, at 
the end of the book, directions for making dietetic prepa- 
rations, and a few additional forms of prescriptions; also a 
Glossary for the purpose of assisting the reader in under- 
standing the medical terms which we have found it neces- 
sary to introduce into the work. 

THE AUTHOR 



PREFACE TO THE FIFTH EDITION. 



The very flattering reception of the earlier editions of this work 
by the public, has, after the elapse of several years, induced the 
author to issue this improved edition. 

He has been influenced by another consideration : Since the 
first production of this work, the evils besetting the lives of females 
have in nowise abated, but rather increased. At the present time, 
there seems to be a desire as well as a great need among women, 
of such information as is contained in this volume. In conse- 
quence, the market has been flooded with several pretentious 
works — mere catchpennies, issued by physicians, so-called, merely 
for the purpose of advertising their noxious nostrums, and calling 
attention to their vile avocations as abortionists. In conse- 
quence, the public ought to be infortned in regard to these matters, 
and have within their reach a true and reliable work upon which 
they can depend in all emergencies. 

There are no literary pretensions here. The author asks nothing 
for himself, but every thing for Science, History, and Natural 
History. By these, the great revelation has been made. Woman 
has been explained to us. The science of ovology has revealed all. 
What was formerly called an impurity in her, is her holiest, her 
most poetic crisis. Nature gives woman to man, feeble, depending 
constantly upon the need of being loved and protected. She is 
glad to rest upon some one. She loves beforehand him to whom 
nature seems to lead her. To stop her, she must have more virtue 
and strength of mind than man. Where the world does not spoil 
her, she is good, and docile, and ennobling to man. What a duty, 
what a privilege for us ! Cherish, then, love her, protect her. To 
a true woman, one moment of genuine love is worth more than all 
the glories of the world. The Author. 



BOOK I. 



THE 



PHYSIOLOGY OF WOMAN. 



AND HER 



DISEASES, 



INCLUDING 



AIL THOSE OF HER CRITICAL PERIODS. 



"When Conscience, History, and Natural History accord — Believe.- 3 •»- 



THE 



PHYSIOLOGY OF WOMAN, 

AND 

HER DISEASES. 



PART I. 

ANATOMY OF ORGANS PECULIAR TO .THE FEMALE. 



CHAPTER I. 

PECULIARITIES OF THE FE3IALE SYSTEM, WITH THE ANATOMY 
OF .ORGANS PECULIAR TO THE SEX. 

There has been a popular belief, which exists to some 
extent in our day, that the human female is almost a dif- 
ferent being from the male. Yet, in fact, although the 
Deity, for the purpose of preserving certain moral and phy- 
sical differences, has imposed a distinctness of organization 
upon the sexes, and allotted to each respective duties which 
cannot be changed, this dissimilitude, though great, is not 
so distinctive as is a by many supposed. In the formation 
of man, it would be idle, by any process of reasoning, to 
decide to which sex is assigned the most important part in 
fulfilling the intentions of nature; they cannot evidently 
be fulfilled by one sex alone. 

• Much may be done through the influences of education 
and modes of life, in varying the female constitution, but 
they are not able to deprive it of its distintive peculiarities. 
When these great agents have been employed under equal 
circumstances, an approximation of similarity has been 
observed ; yet they have never been able to alter the 
character of the female so much, as to leave a doubt to 
which sex the individual belongs.. In those rare cases of 
malformation, where there is a complete absence of the 

B* 



18 PECULIARITIES OF THE FEMALE SYSTEM. 

ovaria, t'le mind and body present an extraordinary assimi- 
lation with those of the male. The delicacy and gentleness 
peculiar to the female is exchanged for the superior firm- 
ness and steadiness of purpose of the male. The differ- 
ence in personal appearance, and fancy for rude sports, 
are also apparent. From these peculiarities, connected 
with certain derangements of structure, occurring some- 
times in females, they give rise to the impression that both 
sexes are combined in the same person, and thus forming 
what have been called hermaphrodites. We need only 
say, that no such being has ever been known to exist in 
the human species ; although there have been many curi- 
ous cases of malformation. 

We have, however, in this place, only to explain the 
peculiarities that distinguish the female from the male, 
which impose upon her, functions and diseases altogether 
her own. For her organization and temperament particu- 
larly adapt her for the contingences connected with the 
processes of conception, delivery and suckling, which she 
is destined to perform. Besides being liable to most of 
the diseases of the male, she is, from the age of puberty, 
subject to irregularities of her own peculiar function, 
menstruation, from which she severely suffers.* 

The anatomical and physiological peculiarities of the 
female are numerous. One of the most evident differ 
ences of the sexes, is the inferiority in stature of the 
female. The bones of her whole system are more deli- 
cate and less extended. Those of the cranium are smaller, 
as also is the space destined to be filled with the brain. 
The connection of the bones with each other, in articulating, 
differ from those of the male, in being better concealed. 
The chest is more elevated, in consequence of the ribs 
forming nearly right angles with the spine. This dispo- 
sition of the ribs renders the chest shorter, though its 
upper part is larger. Of the differences in the bones of 
the pelvis we shall speak hereafter. 

* An eminent medical writer is of opinion, that most of the causes 
which degenerate the human race, originate with the female; he re- 
marks : " The degeneration of the species always begins in nature 
with the female; to study the diseases of them is to arrive at the 
source of all that belong to the human species." 



PECULIARITIES OF THE FEMALE SYSTEM. 19 

The muscular system also differs ; its activity is much 
greater ; and the whole of the fibres of the female, pos- 
sess greater tenuity and sensibility. 

The nerves are smaller and of more delicate structure ; 
they possess greater sensibility, and hence the increased 
susceptibility of impressions', from physical and moral 
causes; hence, also, the rapidity of contraction of the 
muscles, and less permanency of impressions. And thus 
the organization of the muscular and nervous systems, con- 
tribute to render the female more liable to spasmodic dis- 
eases, and exposed to inordinate stimulation from internal 
and external, moral and physical causes. 

In the circulatory system are united the peculiarities 
of the muscular and nervous systems. The circulation 
is carried on with more rapidity, but less force ; the arte- 
ries are smaller, more excitable, and less easily calmed 
when inordinately excited. The veins are more strongly 
marked upon the surface of the body, thus offering less 
resistance to the distension of the blood. 

The cellular system is more abundant and more flexi- 
ble. From its abundance about the articulations of joints 
and large foldings of the body, a roundness and beauty 
is given to parts which in the male are sometimes un- 
sightly. The texture of the skin is much finer in the 
female, more highly polished and transparent, and is, of 
itself, almost an object of beauty. Its sensibility is 
much greater, and its sympathies are more vivid than in 
the male. 

It will be seen, by the peculiarities which we have now 
pointed out, that the female constitution is of a marked 
and in many respects distinct character. There are other 
physical peculiarities contained within and about the pelvis 
which we shall soon describe, endowed with an extent of 
influence that belongs to none of those yet mentioned. 



Notwithstanding the aversion of females, from innate 
and becoming feelings of chastity, for every allusion to the 
organs destined for the continuation of the species, yet, 
from the importance and actual necessity of their having 
a knowledge of those organs, they being the seat of nu- 
merous diseases and accidents, it is unavoidably incum- 



20 



ANATOMY OF ORGANS PECULIAR TO THE FE3IALE. 



bent upon me to give such information in these descriptions. 
While doing so, I 'shall sympathize deeply with her feel- 
ings, and endeavor that no expression shall fall from my 
pen, which may raise a single blush upon the cheek of 
any modest and intelligent woman. 



the pelvis . 
By the term pelvis, from a Greek word, signifying ba- 
sin, is indicated that portion of the abdominal cavity in- 
cluded within the bones of the pelvis, which are four in 
number : the ossa innominata or hip bones, the sacrum and 

Fig. 1.* 




* A front view of the female pelvis. 1. 1. The ossa innominata, 
or hip bones. 2. The sacrum, perforated with two rows of holes for 
the transmission of nerves. 3. The symphysis pubis, or ospubis. 4. 
The coccyx. 5. 5. Articulations for the thigh bones. The anteropos- 
terior diameter of the brim, from symphysis pubis to middle of sacrum, 
measures four inches and a half. The transverse, from the middle of 
the brim on one side to the same point on the opposite, five inches and 
a quarter. The oblique diameter measures about five inches. The an- 
tero-posterior and transverse diameters of the outlet measure each four 
inches. The cavity of the pelvis measures in depth, one inch and a half 
in front, and four inches and a half posteriorly. 



ANATOMY OF ORGANS PECULIAR TO THE FEMALE. 21 

coccyx ; which in the adult are firmly united by what are 
called the symphyses. The triangular space between these 
bones is known as the cavity of the pelvis. It is usually 
divided by anatomists into the brim or inlet, cavity, and 
outlet. The brim is the superior part, and in the female, 
is of an oval form, corresponding with the child's head. 
The outlet is of an irregular form and is the inferior part. 
The cavity lies between them. See Fig. 1. 

In the female,the bones of the pelvis are lighter and more 
delicate than in the male. The inlet, outlet and cavity, 
are larger in the former than in the latter. 

The contents of the female pelvis are, the bladder, va- 
gina, uterus, with its appendages, and the rectum. 

The bladder (4, Fig. 2,) is situated in front, and has the 
uterus immediately behind, from which it is usually sepa- 
rated by a convolution of small intestines. The urethra, 
passage from the bladder, is about an inch and a half in 
length, and passes downwards and forwards to the meatus 
urinarius, opening for the urine, which is situated in the 
vagina, immediately below the symphysis pubis, and be- 
hind the nymphce. See Fig. .2. 

The vagina (12, Fig. 2,) is a membranous canal, lead- 
ing from the external parts to the uterus or womb, and cor- 
responds in direction with the axis of the outlet of the pel- 
vis. It is constricted at its commencement, but becomes 
considerably dilated near the uterus. Its length is varia- 
ble, though it is generally five or six inches. It is in- 
serted into the neck of the uterus, which projects into the 
upper extremity of this canal. 

The uterus (17, Fig. 2,) is a flattened organ, somewTiat 
of a triangular shape, w T ith the base directed upwards and 
forwards, and the apex downwards and backwards, in the 
line of the axis of the inlet of the pelvis. In the natural 
unimpregnated state it is about three inches in length, two 
in breadth at its broadest part, and one in thickness, and 
is divided into fundus, body, cervix or neck, and os uteri 
or mouth of the uterus. At the period of puberty this or- 
gan weighs about one ounce and a half; after child-bear- 
ing from two to three ounces ; and at the ninth month of 
pregnancy from two to four pounds. The membrane 
lining the abdomen, called the per iloneum, envelopes the 



22 ANATOMY OF ORGANS PECULIAR TO THE FEMALE. 

upper part of this organ, forming the broad ligaments, 
which serve with the. round ligaments, which are muscu- 
lar cords situated between the layers of the broad liga- 
ments, in retaining the uterus in its proper position. The 

Fig. 2.* 




* A side view of the organs of the female pelvis. 1. The symphysis 
pubis. 2. The abdominal coverings. 3. A collection of fat forming the 
mons Veneris. 4. The urinary bladder. 5. The entrance of the left 
ureter (passage from the kidney.) 6. The canal of the urethra. 7. The 
meatus urinarius. 8. The clitoris divided through the middle. 9. The 
left nymph*. 10. The left labia majora. 11. The meatus of the 
vagina. 12. The canal of the vagina. 13. The wall of separation be- 
tween the bladder and the vagina. 14. The wall of separation be- 
tween the vagina and the rectum. 15. The perineum (space between 
the vagina and anus.) 16. The os uteri. 17. Its neck. 18. The fun- 
dus. The body of the uterus is seen between the two last figures. 
19. Th^ rectum. 20. The anus. 21. The upper part of the rectum 
covered with the peritoneal membrane. 22. The recto-uterine fold or 
the peritoneum. 23. The uterine fold of the same. 24. The reflec- 
tion of the peritoneum over the bladder to the internal walls of the ab- 
domen. 25. The la>t vertebra of the back. 26. The sacrum. 27. The 
coccyx. 28. The left thigh. 



ANATOMY OF ORGANS PECULIAR TO THE FEMALE. 2S 

appendages of the uterus are also enclosed in this fold of 
the peritoneum. They are the Fallopian tubes and <n&r*eS) 
which will be considered hereafter. 

The rectum (19, Fig. 2,) is the termination of the 
large intestines ; it receives its name from the straitness of 
its form in comparison with the colon above it. It is sep- 
arated from the vagina by a triangular space, the base of 
which is downwards and constitutes the perineum ; its ter- 
mination externally is called the anus. 



CHAPTER II. 



REPRODUCTIVE ORGANS. 



The female reproductive organs, are divided into 
external and internal. The external, are the mons veneris, 

LABIA MAJORA, LABIA MINORA Or NYMPEUE, CLITORIS, MEATUS 

urinarius, and the opening, of the vagina. The inter- 
nal organs are contained within the pelvis,— they are the 
vagina, uterus, ovaries, and Fallopian tubes ; a part 
of which have been already described, but will be re- 
viewed for the purpose of taking a more extended survey 
of them. 

external genital organs. 

The mons veneris, Mt. Venus, is the eminence in front 
of the pelvis. It is covered with a fatty substance, the 
common skin and hairs. 

The labia majora (10 Fig. 2,) are two large longitu- 
dinal folds of integument, consisting of fat and loose cellu- 
lar tissue ; their fissure called vulva, receives the opening 
of the urethra and vagina. The external surface of the 
labia is covered with hairs ; the inner surface is smooth 
and lined with mucous membrane. The commissure, 
formed by the union of the labia, posteriorly, is called the 
fourchette. The use of the labia is to favor the exten- 
sion of the vulva in the passage of the child's head ; 
during which they are completely unfolded and effaced. 

The labia minora or nymphje (9, Fig. 2,) are two 
smaller folds situated within the labia majora. The 
nymphse consist of mucous membrane, and are supplied 
with a number of sebaceous follicles or small glands, and 
contain, in their interior, a layer of erectile tissue. It is 
difficult to conceive the motives for bestowing upon this 
organ a. title which pertains to the divinities that preside 
over fountains. These bodies exercise no influence over 



ANATOMY OF ORGANS PECULIAR TO THE FEMALE. 25 

the sources or direction of the urine, and it is proper to 
say. that their use is unknown. 

The Clitoris (8, Fig. 2,) is a small, elongated organ, 
situated in front of the os pubis, with its point jutting out 
under the summit of the nymphse. This organ has con- 
siderable analogy to the male penis ; its extremity pos- 
sesses a glans, which is provided with two small erectile 
muscles. It is capable of erection, and is endowed with 
intense erotic sensibility. 

Just on a line with the pubic arch is a small projection, 
the vestibule, immediately beneath which, is the orifice 
of the urethra, (7, Fig. 2.) A knowledge of its situa- 
tion is very importtant in passing the catheter, when it is 
necessary to relieve the bladder of its contents. 

At about an inch beneath the clitoris is the entrance of 
the vagina, (11, Fig. 2,) marked by a projecting margin . 

The entrance to the vagina, is generally closed in 
early life by a membrane of a semi-lunar form, which is 
stretched across the opening ; this is called the hymen. 
It is generally perforated near its middle, and is so thin 
and delicate as to to yield to slight force ; therefore it is 
often wanting in adult persons, having probably been rup- 
tured during infancy. Certain it is, that very many young 
persons are met with in whom no trace of it is to be found. 
It has been regarded as a test of virginity ; but the reader 
will understand that it cannot be relied on, since it is often 
wholly wanting, and in other instances so strong as to re- 
quire the knife of the surgeon for its destruction. The 
dogmas upon the subject of the hymen, so frequently give 
rise to distressing doubts and suspicions, that they ought 
to be exploded. 

In some individuals the hymen is not crescentic, but cir- 
cular, with an opening in the centre, or in some other part ; 
occasionally examples are met with in which it is imper- 
forate. Instances also are recorded in which it was so 
firm as to prevent the delivery of the child, till incisions 
were made to obviate the difficulty. The rupture of the 
hymen gives rise to a sort of fringe around the open- 
ing of the vagina ; this Is called caruncula myriiformes. 



The external sexual organs, in the aggregate, are 



20 ANATOMY OF ORGANS PECULIAR TO THE FEMALE. 

indicated by the word Pudendum, from pudor, shame ; a 
word very happily selected as a reference to, rather than 
a direct denomination of, a part of the body which the sex, 
without exception even of many barbarous tribes, en- 
deavor modestly to conceal. We are told, that the first 
sinful indulgence of the human appetites, was succeeded 
by the deepest consciousness of exposure upon this sub- 
ject ; and the fig-leaf which concealed the shame of the 
first woman, is a simple expression or emblem of female 
delicacy. The Venus de Medici is not less expressive 
of female modesty, than of the perfection of the female 
form : its modesty is the key to that inimitable, universal 
and pervading beauty, which places it at the head of 
the ancient works of art, and renders the statue at once • 
a truth in morals, and a profound homage to one of the 
best attributes of woman. — Meigs. 

INTERNAL GENITAL ORGANS. 

The membraneous tube of the vagina connects the ex* 
ternal with the internal organs. It is longer in virgins 
than in those women who have borne many children ; and 
larger in diameter in the latter than in the former, from 
its having been frequently dilated by the passage of the 
child's head. It generally closes speedily after the passage 
of a child, even one of a very large size. The form of 
the uterus is very well represented by a pear, with the 
large part upward — it is larger in those women who have 
borne children. It is composed of muscular fibres, blood 
vessels, absorbents and nerves, which are very small in 
the unimpregnated state ; but in the gravid womb, the 
same, vessels acquire an enormous size, are exceedingly 
numerous, and are furnished with torrents of blood from 
the uterine' arteries. See. the anatomy of these organs at 
page 21. 

The Fallopian tubes, or oviducts, (8, 8, Fig. 3,) 
called also by French writers, uterine trumpets, are situ- 
ated in the upper border of the br Dad ligaments, and con* 
nect with the upper part of the uterus. Each tube is four 
or nve inches in length, and is perforated through its whole 
extent 1 y an exceedingly minute canal, which opens at . 



ANATOMY OF ORGANS PECULIAR TO THE FE3IALE. 



27 



one end into the upper angle of the cavity of the uterus ; 
the other extremity called fimbria, lies loose in the cavity 
of the pelvis, and has gained the appellation of fimbria- 
ted extremity, (9, 9, Fig. 3.) 

Fig. 3.* 




When this fimbria is excited by the veneral orgasm, it 
becomes erect, and is then directed towards the ovum, 
which it grasps and conveys by some vital process not 
very well understood, from its position, through the Fal- 
lopian tube into the cavity of the uterus-; where its 
growth takes place till the birth of the child. (See Preg- 
nancy.) 

The ovaria, (7, 7, Fig. 3,) are two, oblong, flattened, 
oval, and shining bodies, situated in the posterior layer of 
the broad ligaments, and connected with the fundus of the 
uterus at each side, by means of a rounded muscular cord 
— the ligament of the ovaria. The ova, or eggs, are the 

* A section of the vagina, uterus, and its appendages, from side lo 
side. 1. 1. 1. The thick walls of the uterus. 2. The cavity of the 
uterus. 3. The mouth of theuteius. 4. The vagina. 5. 5. The round 
{Laments. 6. The broad ligament, represented only on one side 
/. 7. The ovaria. The ova are represented by the dots. 8. 8. The 
Fallopian tubes, down each of which is seen a black line; this is the 
small passage proceeding from the open ends to the uterus. 9. 9. The 
fimbriated extremities of the tubes, which grasp the eggs for th« 
purpose of conveying them through the tubes to the uterus. A. A 
The commencement of the passages down the Fallopian Pubes. 



29 AMATOMY OF ORGANS PECULIAR TO THE FEMALE. 

germina, or rudiments of the embryo, or child, and are 
contained in the Graafian vesicles. It would be tedious to 
the general reader, to give the anatomical structure of 
these eggs ; they resemble small bags filled with a whitish 
albuminous fluid, similar to that found in the eggs of com- 
mon fowls. They are about the size of a pin's head, and 
vary in number from two to four hundred, or more. 
After the separation of an ova, a yellow spot, the corpus 
luteum, is formed in place of the detatched ovule. In 
process of time, however, the corpus luteum disappears, 
and nothing but a cicatrix remains in the original seat of 
the ovule. 

THE MAMMH, OR BREASTS. 

Another organ of the female which we should not omit 
to describe, is the mammae, or breasts. Their situation 
and form is well known. They exist in the male as well 
as female, but in a rudimentary state. The left mammae 
is a little larger than the right. Near the centre of the 
convexity of each breast, is a small projection called the 
hippie, which is surrounded by an areola having a co- 
lored tint; the color is of a delicate pink in the female 
before impregnation, afterwards it assumes a brownish hue 
which deepens in color as pregnancy advances ; after the 
birth of the child the brownish tint continues through life. 

The mammae, in structure, is a secreting gland, consist- 
ing of lobes which are held together by cellular tissue. Its 
excretory ducts, which are ten or fifteen in number, com- 
mence by small openings at the apex of the nipple and 
pass inward, towards the central part of the gland, where 
they enlarge and give off numerous branches, to ramify 
through the gland to their ultimate termination in the 
minute lobules. 

The direct sympathy that exists between the breasts and 
uterus, has led to the belief that there is an open connec- 
tion between the two organs. It is only necessary to state 
that no such communication in reality exists. Though 
Fallopius and other authors declare that the sympathy is 
produced by an anastomosis of vessels, they have not 
shown how, or where, such connection is to be found. 



ANATOMY OF ORGANS PECULIAR TO THE FEMALE. 29 

The titer as and breasts seem to be a set of organs 
balancing each other in the system ; thus, in pregnancy 
and at the menstrual periods, the uterus is active ; but after 
parturition the action of the uterus subsides, while the 
breasts in their turn become active, and secrete milk. In 
case of inflamation of the uterus, incident to lying-in 
women, the secretion of milk is destroyed ; so when the 
uterus yields the menstrual discharge, the milk is not 
secreted in perfection during a continuance of this dis- 
charge ; nor do we ever find them both inflamed at th* 

same time. 

3 



PART II. 



DISEASES OF THE EXTERNAL GENITAL ORGANS SYMPTOMS, 

CAUSES, AND TREATMENT. 



CHAPTER L * 

m 
DISEASES OF THE LABIA MAJORA 

The external reproductive organs are so constructed 
as to render them liable toa variety of complaints, which 
are apt to excite alarm in the mind of the female, howe- 
ver free from danger they may in reality be. Women, 
especially the married, when laboring under affections of 
these parts, are often kept in a state of great anxiety, 
until they can know the exact nature of the difficulty, 
and that it will not be attended with danger. On this 
account it is important that females be acquainted with 
the diseases to tVhich they are incident, and thus in a 
measure be able to- save their peace of mind, avoid the 
causes which tend to them, and have remedies timely 
applied for their relief. 

1. The labia majora, on account of their looseness of 
texture, sometimes become very much enlarged from 
slight irriu "ion ; this happens frequently with those who 
neglect daily washing of the parts, during, and after the 
menstrual purgation. When there has been a neglect of 
proper cleanliness, the secretions become acrid and pro- 
duce itching ; if friction be indulged in, the parts become 
inflamed and sometimes very much swollen. The same 
thing may take place in regard to the nymphse. There- 
fore it is important that these parts be daily washed with 



DISEASES OF THE LABIA. 31 

warm water, particularly during the flow, and immediately 
after the menses have ceased. 

2. Abscess of the labia sometimes occurs, which is 
extremely painful. The progress of the inflammation 
towards suppuration is sometimes so rapid that but little 
time- is permitted to procure resolution. 

It is caused by blows, falls, forcible intercourse, and 
injuries of any kind may produce it ; or it may arise from 
a general disposition to inflammatory action. 

The symptoms are heat, swelling, redness, and throbing 
pain in the part, extending to the groin and down the 
thigh. On examination, the labia are found to be enlarged, 
a circumscribed hardness is felt, and the part is exqui- 
sitely tender. 

In the treatment, rest and quiet must be adopted ; and 
if the symptoms are severe, leeches at the commencement, 
may be applied to the part, and followed by bread poulti- 
ces and the administration of a brisk purgative of infusion 
of senna with salts. If suppuration be established .the 
leeches may be omitted. Poultices should be applied till ■ 
the formation of matter, when a free incision should be 
made for its discharge. Dr. Dewees recommends in chil- 
dren, where it is difficult to confine a poultice to the parts, 
the application of strong murcurial ointment with turpen- 
tine. 

3. Encysted tumors of the labia are met with of vari. 
ous sizes, and generally circumscribed. They occasioi 
bat few symptoms, except those that arise from their size. : 

In the treatment, simple incision of the tumour may bo 
sufficient, or it may be entirely dfssected out, which is 
probably the best plan. 

4. Warty tumors. — These occur both singly and in 
clusters, generally suspended by a pedicle, from some part 
of the external organs. Their size varies from that of a 
pea to that of a turkey's egg. They are apt to spread inter- 
nally to the vestibule ; but are neither painful or tender, 
and are of inconvenience, only from their size. Their 
color is the same as the natural parts. They are, in many 
cases, of venereal origin, and if suppuration takes place in 
them, as it sometimes does, they are apt to form unhealthy 
sores. 



32 DISEASES OF THE LABIA AND NYMPHS. 

The treatment is by excision, either with the knife, 
scissors, or ligature. If there is a suspicion of syphilis, 
mercury, in some one' of its forms, must be given. The 
invalid is to be kept quiet, upon a moderate diet, and have 
the bowels freed occasionally with medicine. 

5. In young children it sometimes hapens that the 
inner faces of the labia become irritated, which results in 
inflammation, uniting the surfaces in contact. 

The treatment required in these cases, is to separate 
the united surfaces by gently drawing them apart, and 
with the end of a probe divide the adhesions. It is some- 
times, though rarely necessary to use the knife, unless the 
operation be delayed till womanhood. Such adhesions 
arise from a want of cleanliness ; therefore parents should 
be sure that these parts are regularly cleansed every time 
the child is washed, by carefully separating the labia. 
They should then be tenderly dried with a soft cloth, and 
may be dusted with powdered starch. Affections of the 
labia, resulting from pregnancy and child-bearing, will 
hereafter be considered. 



CHAPTER II. 



DISEASES OF THE NYMPHS. 



The nymphjs or lesser labia, are subject to enlarge- 
ment, when they are changed from a red to a dark color, 
become dense and sometimes covered with little tumors, 
resembling warts ; these, in cold weather, are subject to 
excoriation, especially if they protrude beyond the exter- 
nal labia, as they sometimes do. 

In the treatment, we prescribe rest, free purgation with 
senna and salts, and if there be much inflammation, the 
application of leeches near the part. A soft bread and 
milk poultice should be applied once in three or four hours. 
When such means fail, and the affection becomes chronic, 
the protruding part must be removed by fhe knife or scis- 
sors, which is a safe operation. A similar one is performed 
by the Arabs and Moors, in applying the rite of circumsci- 
sion to their young females. 



CHAPTER m. 



DISEASES OF THE CLITORIS. 



The clitoris is sometimes the seat of cancer, when 
there is no alternative but extirpation by the knife, which 
should be done early, in order to be successful. It also 
sometimes becomes enlarged from inflammation, when cool- 
ing and astringent lotions may give relief. It is some- 
times necessary to resort to the amputation of this organ 
for such enlargements. 

It is the malformation and enlargement of this part, 
which have given rise to the absurd opinion of hermaphro- 
dites. The existence of such a being, has gained the 
assent of the greater part of mankind ; but Dr. Francis 
informs us that the latest decisions in juridical medicine, 
reject the possibility of both sexes in the same individual 
of the human species. 

Dr. Meigs remarks, that "notwithstanding monoecious 
plants, and some of the lower orders of the animal king- 
dom, contain within their bodies, the organs of a double 
sex, we are not authorized to admit that a similar condition 
can occur in beings of a. highly complex organization, 
where an entire individuality of the male and female are, 
and must be indispensible." 



CHAPTER IV. 

IMPERFORATION AND TOO GREAT DENSITY OF THE HYMEN. 

The hymen is sometimes imperforate, ahd at others, of 
too great density, though perforated sufficiently for the 
passage of the menses.. 

In the first case, no inconvenience is experienced, till 
after the age of puberty ; then, the menstruous fluid is 
duly secreted, but finding no outlet, is accumulated within 
the uterus. Such persons suffer pain, only at each return 
of the menstrual period. In cases where the uterus has 
been completely filled, the pains so much resemble those 

C 



34 INFLAMMATION OF THE VULVA. 

of labor, that they have sometimes been mistaken foi 
them; they, at this stage being very severe. 

The remedy, in all instances, seems to be the same ; it 
is simply to cut through the confining membrane, when 
the fluid will be immediately discharged. 

2. In the rare cases of too great density of the hymen 
with a small opening, it seems that it does not always pre- 
vent conception, notwithstanding its embarrassing effect. 
A number of such unquestionable cases are on record, in 
which the woman became pregnant, and the child easily 
delivered after the operation of dividing the rigid hymen. 



CHAPTER V. 

INFLAMMATION of the vulva. 

Inflammation of the mucous membrane of the vulva, 
occurs at all periods of life, but differs according to the age 
of the patient. 

In children, it occupies the whole mucous membrane 
of these parts, and sometimes spreads to the vagina, pro- 
ducing a profuse milky discharge, called by authors, infan- 
tile leucorrhea. This form is seen at all periods after 
birth, in infants as well as older children, mostly among 
the neglected, and children of the poor. The causes are 
cold, mechanical injuries, want of cleanliness, etc. 

The symptoms are local uneasiness, and scalding of the 
urine. The mucous membrane is inflamed and puffy, and 
after some time there is observed a thin and colorless dis- 
charge, which soon becomes copious, thicker, and of a yel- 
lowish color. It is often of an acrid character, excoriating 
the skin at the margin of the external organs. 
[, The treatment of the milder form is simple and gene- 
rally successful. When there is much irritation, the 
parts should be fomented three or four times a day, with a 
decoction of marsh mallow leaves or poppies. After each 
fomentation, the parts being dried, black-wash or a weak 
solution of sugar of lead, or sulphate of zinc may be applied. 
When the disease is obstinate and becomes chronic, a lotion 
of nitrate of silver, (10 grains to the ounce of water,) is 
preferable. 



PRURITUS, OR ITCHING OF THE VULVA. 35 

The child must be kept quiet, upon a moderate, unstimu- 
laiing diet. Laxative medicines must be occasionally 
given. If there is a tendency to adhesion, lint, spread 
with simple ointment, should be placed between the labia. 
If the child becomes weakened by a continuance of the 
disease, Peruvian bark must be given internally, and wine 
may be allowed in moderate quantities. Should diarrhea 
occur, chalk mixture with opium may be given. 

2. In adults, inflammation of the vulva is more cir- 
cumscribed, giving rise to a discharge of transparent mu- 
cous only. The pain is incalculably more severe. It is 
more common among married women, especially newly 
married. The causes and symptoms are about the same 
as those mentioned under infantile leucorrhea. The treat- 
ment generally should be more antiphlogistic than there 
directed ; in severe .cases, leeches, to the parts, with saline 
purgatives to keep the bowels free, and poppy fomentations, 
are all the remedies necessary, in addition to those before 
mentioned. In both cases, extreme cleanliness should be 
observed, with a spare diet. 



CHAPTER VI. 

pruritus, or itching of the vulva. 

Pruritus, or itching of the vulva, is one of the most 
troublesome and distressing complaints, to which the 
female is subject. It is sometimes symptomatic of other 
diseases, as of the uterus, bladder and rectum. Women 
who are not pregnant are subject to it, though not equally 
liable. 

The symptoms are uneasy sensations of itching, prick- 
ing, tingling, etc. ; the desire to scratch is so indomitable, 
as sometimes to put decency to defiance. If the complaint 
be not arrested, the patient will be reduced to a very me- 
lancholy condition ; unfit for society, solitude leaves her 
to the uncontrolled exercise of her imagination ; her mind, 
influenced by the excitement of the organs affected, is oc- 
cupied by lascivious thoughts and impure desires, and her 
conduct, " in defiance of herself," towards the other sex 
is in keeping, with her depraved disposition, 



36 PRURITUS, OR ITCHING OF THE VULVA. 

The causes are various ; a common one, is an efflores- 
cence of the aphthous kind, first pointed out by Dr. Dew- 
ees, of Philadelphia; several kinds of eruptions ; acrid 
secretions within the labia ; irritation from pregnancy ; 
want of cleanliness ; worms, etc. 

The treatment will be determined by the location of 
the irritation, and constitution of the patient. Dr. Dewees 
places most of his reliance upon borax, especially in those 
cases which depend upon an eruption of the parts. lie 
used it in the form of a solution in water, which was freely 
applied to the parts affected; and certainly great reliance 
is to be placed upon this article. When the complaint 
proves obstinate, depletion by purgatives and blood letting 
adds much to the influence of the borax.* In all cases, 
care must be taken to remove irritating collections from 
the rectum, if any exist. The strictest cleanliness must 
be observed, to facilitate which, the parts should be gently 
washed, three or four times a day, with warm milk and 
water, and carefully dried. Iced water, or cold water 
with a few drops of nitric acid, is useful in giving tempo- 
rary relief in severe cases. 

Other astringents than borax are often used with suc- 
cess ; as a solution of sugar of lead, alum, and sulphate. 
of zinc. When these have failed, balsam copaiva, and 
dry calomel, applied to the parts have succeeded. Some- 
times the irritation extends up to the vagina ; then it is 
necessary to apply the remedies with a syringe. 

Alterative medicines, such as sulphur, decoction of sar- 
saparilla, etc., internally, and a few grains of cicuta or 
hyosciamus, to allay irritation, are often very beneficial. 
These remedies, or a selection from them, apply,, of 
course, to those cases in which the disease is local. If the 
patient be pregnant, palliative means will suffice, as the 
disorder generally disappears after delivery. In both 
cases, the diet should be very moderate, with abstinence 

* The following form is the best mode of using it, which rarely fails; 
viz.: — Borate of Soda, half an ounce;, Sulphate of Morphine, aix grains, 
Distilled Rose Water, eight ounces ; to be made into a mixture ac- 
cording to art and applied three times a day to the affected parts, by 
means of a bit of sponge or a piece of linen, after having washed the 
surfaces wnh tepid water and soap, and dried them. 



DISEASES OF THE EXTERNAL ORGANS. 37 

from stimulants of every kind. The patient should resist 
the inclination to obtain relief from itching by friction, 
and all means calculated to improve the general health, 
should be employed, as moderate exercise, bathing with 
tepid water, shower bath, etc. — th^se have been found 
particularly serviceable. 

There are other affections of and near the external 
organs, of a character similar to some of those already 
described, as oozing tumors of the labia ; tumors and 
thickening of the membrane at the orifice of the urethra: 
tumors in the pelvis, external to the vaginal canal ; and 
abscesses between the vagina and rectum. 

'When these various affections occur, which is not com- 
mon, the principles of treatment are the same as before 
directed for other and similar ones. In all excoriations 
and discharges, whether such discharges arise from the 
parts themselves, or merely pass over them, as in leucor- 
rhea or whites, the strictest cleanliness must be observed. 

[For additional forms of prescriptions and dietetic 
preparations, the reader is referred to the close of the 
book.] 



PART III. 



PHYSIOLOGY OF THE INTERNAL GENITAL ORGANS. MEN- 
STRUATION NATURE TIME OF OCCURENCE AND QUAN- 
TITY. — IMPERFECT PUBERTY, WITH HYGIENIC RULES FOR 
ARRIVING AT HEALTHY .MENSTRUATION. 



CHAPTER I. 

PHENOMENA OF THE PHYSIOLOGICAL AND MORAL CHANGES 
WHICH OCCUR IN THE FEMALE DURING CHILDHOOD AND AT 
PUBERTY, WITH HYGIENIC RULES FOR THE NORMAL DEVEL- 
OPMENT. 

We have* already spoken of the peculiarities of the 
female constitution (Chapt. I., Part I.) of adult age; we 
here purpose briefly to trace the occurrence of those differ- 
ences; and others of a moral character, which so eminently 
distinguish the female from the male constitution — leaving 
out the particular consideration of early infancy, which 
will be treated of- in Book II. of this volume. 

What subject,' indeed, is more worthy o'f our attentive 
meditation, than the series of changes, physical, moral, 
and physiological, that accompany every stage of woman's 
existence ! By a long succession of modifications and 
revolutions, she discloses all the phases of her constitution. 
In infancy, she differs slightly from the male, in whose 
pleasures and amusements she participates, as well as in 
his dispositions and tastes, his inconstancy and vivacity. 
At that early period; ignorant of her own sex, ignorant, so 
to speak, of her own nature, the blush of modesty does 
not mantle on her cheek, and her eyes, which reveal no 
passions, seem to seek only what has reference to her own 
real wants. (Colombat.) 



PHENOMENA OF CJIILDIIOOD AND TUBERTY. 39 

It may be remarked, that generally the female in font 
is less robust, and consequently its care is less fatiguing 
to the nurse, than that of the male. Both, however, thus 
early, are subject to the same class of diseases ; they are 
principally liable to convulsive affections, and especially 
to inflammation of the brain, on account of the head in 
infancy being of a greater proportional size, than at any 
other age, and a vital centre, towards which the efforts of 
the organism are mostly directed. These are important 
facts, not to be lost sight of, in the early management of 
the infant ; if, indeed, this susceptibility of the brain to, 
disease, and other necessary facilities for establishing the 
functions of the female infant without improper interrup- 
tion, be not regarded, the ground work of maladies may 
be formed at this period, which will consign her to a pre- 
mature grave, or if she survive, deprive her of all the 
charms which render life agreeable and endurable. 

Great errors exist in rearing the children of the wealthy 
and luxurious. The "ten thousand aches and pains" to 
which they are subject from voluptuous living, more than 
counterbalance the coercive carelessness of the indigent. 
The children of the latter are not so precocious, and when 
they are provided with sufficient nourishment and cloth- 
ing, they are far oftener athletic and intellectual than 
those of the pampered rich. 

No sooner does the infant make its appearance in this 
" world of trouble," than it' is subjected, in its manage- 
ment, to the distressing results of an ignorance of nature's 
laws. " First, an ignorant nurse is permitted to squeeze 
its lungs into the narrowest compass with a bandage enve- 
loping again and again its fragile form ; then its intestines 
are irritated with castor oil, and various nostrums, when 
paregoric, Godfrey's cordial, Dalby's carminative, etc., 
etc., are given to allay the pain produced by the medicine ; 
then it is fed with pap, composed of crackers, boiled flour, 
and various other improvements upon its natural diet. It 
is jolted on the knee, or rocked in a cradle immersed in 
a feather bed, till exhausted nature comes to its relief, and 
it sleeps. This process is continued from day to day ; its 
head is sweltered with a cap — it is half suffocated with 
the heat of the nursery, or beneath heavy bedcloths — and 



40 PHENOMENA OF CHILDHOOD AND PUBERTY. 

so it struggles through its early infancy, if it does not die* 
with dropsy of the brain during its teething, the most 
frequent result of the exhaustion of the nervous system, 
consequent on this shocking ignorance." 

These are important facts, and not to be disregarded. 
"What matter is it if they (the poor) be not able to elicit 
the admiration of foolish drawing-room spectators by their 
infantile efforts ? Far oftener do they develope their pow- 
ers in the hall of science, or in the senate. What though 
a puny race of offspring attest not the folly of their early 
marriage ? a well developed and healthy maturity shall 
be rewarded with, children who will do honor to their 
parents, and aid them in their declining years. Until 
these facts are attended to, our daughters, though they 
may glory in their early beauty and accomplishments, 
will have to lament their premature old age — ay, and 
their mental feebleness besides ; for there can assuredly 
be no great intellectual energy in a body whose failing 
powers are constantly taxed to their fullest extent with the 
mere effort of living." In Book II. of this work we shall 
endeavor to point out the causes^ which may affect the 
child before its birth, and in the chapter on "Imperfect 
Puberty," we shall speak more fully of the causes of pre- 
cocious temperaments, to which we invite particular atten- 
tion. 

What we have to say further upon the subject of this 
chapter, may be regarded as an abstract of- the excellent 
remarks'of Dr.. Colombat de L'Isere upon the phenomena 
and hygiene of puberty — better than which, we can pre- 
sent nothing to the reader. 

If the female have been reared under favorable circum- 
stances, the shades of difference in the sexes soon assume 
a more decided tone, and her peculiar character becomes so 
much the more marked as the development is more com- 
plete, and she approaches the period (puberty) when nature, 
by a sudden change, reveals the completion of those chang- 
es, which she has been so silently making. 

The interval between the tenth year and the age of 
puberty, is a period of transition, a sort of passage from 
childhood to adolescence, which appears to be the happi- 
est era in the life of the female. Her extreme nervous 



PHENOMENA OF CHILDHOOD AND PUBERTY. 41 

mobility prevents her being too long impressed by the 
grave sentiments that might be fitted to interfere with her 
happiness. This being, for young women, the period of 
gentle pleasures and the freest gayety, it follows that 
imagination exhibits every object under the most attract- 
ive colors, and that the existence of young females is 
agreeably varied by a piquant freedom of action and a 
great mobility of tastes and affections. Exempt, at this 
age, from cares and troubles, they sing, they weep and 
laugh at the same moment; and, as their joys, so their 
pleasures and their grief, as well as all their other impres- 
sions, are ephemeral ; they proceed along a flowery path 
up to the age when nature calls on them for. the tribute 
which they owe to the species. 

The young girl, who, until now, was an equivocal, non- 
sexual creature, becomes a woman in her countenance and 
in all the parts of her body, in the elegance of her stature 
and beauty of her form, the delicacy of her features, in 
her constitution, in the sonorous and melodious tones of 
her voice, in her sensibility and affections, in her charac- 
ter, her inclinations, her tastes, her habits, and even in her 
.maladies. Very soon are all the traits of resemblance 
between the two sexes, found to be effaced. The bud, 
newly expanded, blossoms amongst the flowers, and this 
brilliant metamorphosis is signalised by the rosy tints of 
the lips and cheeks, and the perfect development which 
discloses the arrival of the age of puberty. 

This important period, this first moment of triumph in 
which nature seems to renew herself, is announced by 
various striking and admirable phenomena which put an 
end to the social inertia in which the young girl had lived 
from the period of her birth. The genital organs soon 
become a centre of fluxion ; nature makes great efforts in 
order to establish the periodical discharge, and the whole 
machine experiences, in its inmost recesses, a succussion, 
a violent commotion, a general movement. The new 
energy of the uterus impresses a powerful impulse upon 
the entire system of organs ; their functions become more 
active ; the body grows with rapidity ; the various por- 
tions of the figure become more expressed, and bring out 
those graceful contours which belong t the tender sex 

C* 



i2 PHENOMENA OF CHILDHOOD AND PUBERTY. 

alone. At the same time other important changes take 
place; the pelvis and genital organs, which were in a 
rudimentary condition only, now acquire their full pro- 
portions, and many changes occur which will he enume- 
rated in the next chapter, imparting to the surface of the 
body a voluptuous embonpoint which lends the highest 
splendor to the attractive beauty and freshness of youth. 
The physiognomy of the young woman lias now 
acquired a new expression; her gestures bear the stamp 
of her feelings; her language has become more touching 
and pathetic; her eyes, full of life but languishing, an- 
nounce a mixture of desires and fears, of modesty and 
love — in fine, everything conspires to excite, to caress and 
to incite. 

Her tastes, her enjoyments and her inclinations are 
modified like the rest; her most pressing want is to expe- 
rience frivolous emotions; she is passionately given to the 
dance, shows, and company; the curiosity so natural to 
her sex acquires new force and activity; she devours 
books of romance, or more than ever fervent in de vol ion, 
is excited by the expansive passions, and particularly by 
religious piety, which is to her a sort of love. 

At this brilliant period of life, her moral, which depends 
Upon her physical condition, undergoes great mutations. 
The young girl becomes more tender-hearted, more sensi- 
tive, more compassionate, and appears to attach herself to 
everything about her. The new sensations of her soul 
make her timid in approaching the companions of her 
childhood; a strange trouble, a sort of restlessness, an 
agitation before unknown, are the heralds of a power 
whose existence she does not even suspect. 

The action of the new forces of vitality, established 
within the genital organs, augments more and more, and 
reacts with energy upon the whole system. Under the 
sympathetic irradiations of the uterus, the general sensi- 
bility becomes changed, and even excited in a peculiar 
manner. A new sentiment soon gives rise to desires, 
which, as yet, have no definite object, and to vague emo- 
tions, of an instinct that seeks some object — it knows not 
what. This rising want produces the impressions of a 
touching melancholy, a charming bashfulness, whose priu* 



HYGIENIC RULES FOR THE DEVELOPMENT OF PUBERTY. 43 

ciple is founded in ingenious love, presaging new disposi- 
tions and announcing that the inclinations and habits of 
childhood are exchanged for other sentiments. The young 
virgin becomes timid, reserved, abstract and dreamy. She 
sighs less for pleasure than for happiness ; the necessity 
of loving makes her seek solitude — and this new want, 
that troubles her heart and engages it wholly, becomes, 
if it remain unsatisfied, a source of multiplied disorders 
and derangements. 

There are various causes which have the effect of either 
retarding or hastening the period of puberty. These we 
shall speak of more fully in the chapter on " Imperfect 
Puberty"; some of them are sedentary habits, and a lux- 
urious life ; much and early excitement of the brain, and 
emotions.; the perusal of obscene romances ; the theatre ; 
the ball room ; masturbation, etc. But these artificial 
means, as will hereafter be seen, are always highly injuri- 
ous to the constitution. The normal puberty is announced 
by the eruption of the menses, and is observed about the 
fifteenth or sixteenth year. 

In general, the crisis of puberty is more distressing for 
females than for males; especially for those who are 
endowed with a very delicate and nervous constitution, as 
often happens to such as lead a sedentary life, and have 
acquired the habits and manners appertaining to the opu- 
lent and luxurious classes. (See Chap. II., Part III.) 

HYGIENIC RULES FOR THE NORMAL DEVELOPMENT OF PUBERTY. 

When the young female indicates, by the unfolding of 
her physical functions, that she is approaching the com- 
pletion of her full development, she needs the closest 
attention, and a management suited to counteract the ten- 
dency of her childish constitution. Whereas, before 
puberty, she existed but for herself alone ; having reached 
this age, the spring-time of life, when all her charms are 
in bloom, she now belongs to the entire species which she 
is destined to perpetuate, by bearing almost all the bur- 
then of reproduction. 

As at this period, the instinct of modesty often leads 



44 HYGIENIC RULES FOR THE DEVELOPMENT OF PUBERTY . 

young girls to conceal their first menstrual flow, it becomes 
the duty of mothers to inform them of the revolution they 
are about to undergo, and to announce to them that the 
sanguine discharge, which they are to become subject to, 
is a natural function, upon which their health will hence- 
forward depend. Young persons, kept in entire ignorance 
upon this point, and taking their new condition for some 
shameful infirmity, have been known to oppose the salu- 
tary efforts of nature, by means of lotions, injections, and 
other equally dangerous agents. The exact truth, there- 
fore, should be told to girls just arriving at puberty, as it 
is very dangerous for them to remain entirely ignorant. 

The general attention required by young females, at 
entering the brilliant and stormy crisis, which is termi- 
nated by the appearance of the menses, will now be 
detailed. A carefully regulated diet, is of all means the 
most appropriate for moderating the excitement and disor- 
der resulting from the momentary plentitude of the circu- 
latory system. The food of a young girl ought to consist, 
principally, of vegetable substances, of preparations of 
milk, of the tender meats, and of light and easily digesti- 
ble substances. Water and milk, with cooling drinks, 
should form the chief part of her drink. Solid and highly 
seasoned meats, sour and unripe fruits, stimulating arti- 
cles, alcoholic liquors, as well as the daily use of coffee 
and tea, must be carefully avoided. Tepid baths, taken . 
from time to time, will contribute, together with the regi- 
men, to produce a general detergent effect, and will have 
the advantage, moreover, of softening the skin and dis- 
persing the cutaneous eruptions, to which girls are par- 
ticularly subject, at the period of puberty. 

For the purpose of placing the genital organs, in a 
condition favorable to their becoming the seat of the irri- 
tation which preceeds the menstrual exhalation, we 
should advise gymnastic exercises, walking, riding and 
running ; the game of battledore, the jumping rope, the 
hoop, and riding on horseback ; lastly, friction about the 
pelvis and inferior extremities, the wearing of flannel 
drawers, etc, are additional means very useful for invit- 
ing the flow of the menses. If the important function 



HYGIENIC RULES FOR THE DEVELOPMENT OF PURERTY. 43 

delay its appearance too long, and particularly, if the 
girl suffer any of the evil effects of amenorrhea, we 
should resort to very warm hip and foot baths, and to all 
those means which will be pointed out in the chapter upon 
tardy appearance of the menses. These means, of course, 
should be applied under the direction of the medical adviser. 
At this period, in particular, must be forbidden the wearing 
of corsets with busks and whalebones, and tight clothing, 
which obstruct the free development of the pelvis, of the 
thorax, and of the neck, and which might prove the origin 
of most of the diseases, whose sad picture we shall here- 
after sketch* 

At the same time, attention to the moral condition of 
the female should not be omitted ; for this reason, young 
girls should be removed from boarding school, when they 
approach the age of puberty, in order to exercise a con- 
stant care over them. We should prevent, as far as pos- 
sible, the false emotions produced by the reading of licen- 
tious books, especially of the highly-wrought romances of 
the modern school, which are the more injurious, as all 
the faculties become, as it were, overpowered by the 
desire to experience the sentiment which these works 
represent in an imaginary and exaggerated strain. Fre- 
quent visits to the theatre, ought to be carefully avoided, 
because they, also, may give rise to sensations conforma- 
ble to the moral condition, which is naturally, at puberty, 
already too much exalted. These powerful exciting agents, 
and still more frequently, the violent intimacies formed 
at boarding-school, tear the veil of modesty, and destroy 
forever, the charming innocence, which is the most attract- 
ive ornament of a young girl. Endowed with an organi- 
zation eminently impressionable, she soon contracts im- 
proper habits, and constantly tormented by an amorous 
melancholy, becomes sad, dreamy, sentimental and lan- 
guishing. Like a delicate plant, withered by the rays of 
a burning sun, she fades and dies under the influence of 
a poisoned breath. The desires for happiness and love, 
so sweet and attractive in their native truth, are in her 
converted into a devouring flame, and mastureation, that 
execrable and fatal evil, soon destroys her beamy, impairs 
3* 



46 HYGIENIC RULES FOR THE DEVELOPMENT OF PUBERTY. 

her health, and conducts her almost always to a prema 
ture grave! 

Comme une fleur dessechee 
Tombe, la tete penchee 
Feuille a feuille, sur le sol ; 
Ainsi meurt la palivre fille. 
En elle plus rien ne brille, 
Que les perles de son col. 

[Berthand.] 

It often happens that, in spite of all the care and pre- 
caution of a tender and prudent mother, the imagination 
of a girl becomes exalted to such a point, as to silence 
the voice cf reason and shame. In this unequal contest, 
where natvire often gains the victory over social institu- 
tions, we should resort to the use of means, which may ; 
by a powerful diversion, counterbalance and destroy the - 
erotic exa tation. Experience has proved, that among 
these mean 3, severe occupation of the mind, and bodily 
exercises carried so far as to induce fatigue, are more 
efficacious than all the drugs of the apothecary ; the 
Fable which represents the chaste Diana as the goddess of 
the chase, is an ingenious allegory, which seems to prove 
that the ancients had discovered, in corporeal exercises, 
the power of blunting, and even of extinguishing the 
stings of love. A strict superintendence ; a milk and 
vegetable diet ; the study of history, geography and 
belles-lettres ; counsels founded upon religion and mo- 
rality ; the frequent use of cold bathing ; the precaution 
never to leave young persons alone, and especially to 
make them retire late and rise early ; such are the means 
to which we may almost always resort with success. 

A directly opposite plan should be adopted for girls 
who, though arrived at the age of puberty, are cold, apa- 
thetic, and indifferent ; and it is to such only that the cul- 
ture of the fine arts, the frequenting of balls, of theatres, of 
crowded assemblies, and even the reading of certain 
imaginative works and romances, will not be hurtful, and 
might even prove useful in exciting their sensibility, and 
thus inviting the menstrual exhalation. 



CHAPTER II. 

THE APPROACH OF MENSTRUATION. 

There is at certain periods, from the time of pubern 
to the approach of old age, a discharge of fluid resem- 
bling blood, from the uterus, and its appendages, of every 
healthy woman, who is not pregnant, or who is not suck- 
ling. This discharge is peculiar to the human female, and 
from its returns being monthly, it is called menstruation, 
from the Latin word mensis, signifying month. 

There are several exceptions to this definition. It is 
said that some women never menstruate ; that some men- 
struate and continue to give suck ; and others are said to 
menstruate during pregnancy ; but the definition is gene- 
rally true, such cases being extremely rare. There are, 
however, many morbid causes that derange this function, 
which may diminish or increase the natural amount, or 
suppress it altogether. As these subjects are all of the 
greatest importance, we shall hereafter treat of them at 
length. 

The first appearance of the menses, in this climate, is 
observed at about the age of fourteen or fifteen years, and 
it ceases to recur at about the forty-fifth year of the indi- 
vidual's age ; though it may appear considerably earlier 
or later. At whatever time of life it comes on, a woman 
is said to be at the age of puberty ; though of this, it is a 
consequence, not a cause. The early or late appearance 
of the mensem, depends upon the climate, the constitution, 
the modes of living, and upon the manners of those with 
whom young women associate. The early appearance is 
facilitated by the use of very nutritious food, the constant 
use of wines, coffee, etc. ; as also by the reading of love 
novels, amorous conversation, waltzing, and in short, any 
thing of this description, assists in promoting puberty ; 
those who reach it, however, by artificial means, and much 
before the natural period, will have to suffer for it in after 
life. 



48 THE APPROACH OF -MENSTRUATION. 

When, by the regular process of nature, .he female 
constitution becomes matured, the period of puberty is 
indicated by the regular establishment of this function, 
which is an evidence of her ability to bear children. It 
constantly keeps pace with the development of her con- 
stitution ; where this is rapid, it will appear proportionably 
earlier ; where this process is slower, it will be later in 
appearing. 

It may be proper to say that in some cases impregnation 
has taken place before there was a colored discharge from 
the vagina. The explanatian of this seeming exception, 
appears to be in the fact of no very rare occurrence, that 
the menstruous evacuation, for the first few periods, may 
be a colorless, serous discharge. This is especially the 
case with those in whom the discharge appears early ; it 
may be mistaken for leucorrhea, and care should be taken 
that its suppression be not attempted. 

We shall endeavor to detail in a plain manner, the causes 
which may give rise to derangements of this most impor- 
tant function, so that when there is a departure from the 
original plan of nature, our readers may feel that they 
possess a degree of information upon this subject, which 
will enable them to favor the laws of their being, and 
avoid the many useless and hurtful medicines prescribed 
by the ignorant. When the proper period has arrived, and 
nature has perfected her work, as regards development, if 
allowed to exercise her powers, unimpeded by the indis- 
cretions of the patient, and the ignorance of quacks, she is 
able, when evident obstructions are removed, by the innate 
agency of her own forces, to effect her purpose. 

When the menses are about to appear, they are gene- 
rally announced by a variety of changes ki the constitu- 
tion, and symptoms of greater or less severity. It being 
at this epoch that nature perfects her work, it is the period 
of the most perfect beauty, of which the female is suscep- 
tible ; it is the one at which the moral changes are not 
less remarkable than the physical ; it is a moment, of all 
others, the most replete with consequences to the inexpe- 
rienced and confiding female. Dr. Dixon remarks, 
in relation to the changes which occur when the young 
female is about to pass into the state of womanhood, 



THE APPROACH OF MENSTRUATION. 49 

* that they are sufficiently evident to the observer to 
make this period of life most interesting, and to elieite 
our warmest sympathy, and all the kindlier feelings of 
our nature. How sensitive — how tremulous is now her 
nervous system ; how susceptible to every gentle emotion 
of the soul and how delicately alive to friendship. Happy 
is she who shares the council and sympathy of a fond and 
intelligent mother — a mother, whose intellect and instincts 
both combine to convince her of her duties to her child. In 
such language as a mother alone can use, and with a pur- 
pose as pure and holy as she alone can feel in the discharge 
of that duty, let her communicate as far as she shall judge 
expedient, the end and object of nature in this novel and 
extraordinary change. Much useful counsel and caution, 
that may save both many a heart-felt grief, may be com- 
municated by a mother to an intelligent child, without 
raising a blush upon the cheek of either ; and very dear 
in after life will be the reflection of both, if this duty be 
faithfully performed." We will endeavor to aid her, by 
giving an outline of the various phenomena that precede 
the approach of the menses ; although it is doubtful, if in 
any two cases, its appearance is accompanied by the 
same order of symptoms. 

Among girls who have been delicately and luxuriously 
brought up, a great variety of nervous symptoms, as they 
are called, precede the appearance of the menses ; such 
as ringing in the ears ; palpitation of the heart • starting 
from slight and sudden noises ; loathings and cravings of 
the appetite; convulsive twitchings ; irascibility of temper, 
etc. — all of which are immediately relieved by a trifling 
discharge from the vagina. There is often a determina- 
tion of blood to the head, lungs, breast, stomach and bow- 
els — also to the genital system, producing a sense of 
weight, burning of urine, pain in the back and loins — all 
of which announce the approaching discharge. . 

At this period, also, other interesting and curious pheno- 
mena present themselves : the cheSt expands, the neck and 
throat increase in size, the mammae swell, the nipples pro- 
trude, and in short, the whole system is expanded and 
enlarged. The complexion is improved, the countenance 
is more animated and expressive, the tone of voice becomes 



50 THE APPROACH OF MENSTRUATION. 

more harmonious, and the conversation more intelligent 
and agreeable, the mind no longer being engaged in child- 
ish amusements — in a word, a new being, almost, is crea- 
ted. 

In some girls, the menses appear without any preceding 
indisposition ; but in general, some of the foregoing symp- 
toms present themselves, which are followed by a colorless 
discharge that soon becomes red, when they abate ;- some- 
times, however, returning with less violence for a few peri- 
ods. The first period disappears in three or four days, and 
the female does not become regular till the third or fourth 
one ; that is, she does not assume the exact time and quan- 
tity that is to be in future her standard of health. 

In by far the majority of persons, after the menses are 
properly established, few, if any of these troublesome 
symptoms accompany its eruption ; it not uncommonly 
appears with so little premonition, as to surprise the female 
very awkwardly. There are cases, however, which we 
shall consider in treating of deranged menstruation, 
wherein many annoying and painful symptoms arise at 
every period during life. Such unfortunate females are 
subject to colic pains, headaches, hysterical symptoms, 
violent spasms, sickness of the stomach, vomiting, etc. — 
while in others the digestive functions become deranged 
and painful. "Let all such, carefully study the exciting 
causes that precede one of their worst periods ; they will 
soon perceive whether it be fatigue, indigestible food, 
stimulating drinks — such as strong tea, coffee, etc. — and 
learn to avoid the cause, over which, when in action, medi- 
cine has very little control." 

The menstrual period, for the most part, continues from 
three to five days, and then gradually disappears, leaving 
a state of slight lassitude which is dissipated in a day or 
two ; so the female is not free from the discharge more 
than from twenty-two to twenty-five days at a time ; and 
there are many examples met with, in which the period of 
its duration is not less than seven or eight days for each 
menstruation. 



CHAPTER III. 

THE PHYSIOLOGY OF MENSTRUATION. 

It was formerly a matter of much uncertainty from 
whence the menstrual discharge proceeded ; some sup- 
posed it came from the uterus alone, and others from the 
vagina, or both. But this question is now decided, as far 
as those two organs are concerned, from its having been 
repeatedly seen flowing from the mouth of the uterus, in 
cases of prolapse of that organ. What part of it is sup- 
plied by the ovaria, is not yet precisely known. 

From the earliest time to the present day, much has 
been written by ingenious philosophers, in endeavoring tc 
point out the proximate cause, of this peculiar habit of the 
female. The influence of the moon, was very early 
assigned as the cause ; this opinion arose in consequence 
of the function being periodical, and its observing a lunar 
interval. To destroy this hypothesis, it is only necessary 
to state the fact, that there are women menstruating each 
hour of every day in the month and year. It has also 
been attributed to a 'plethora of the constitution, or of the 
uterus, it having been presumed that women were more 
disposed to plethora than men ; and to get rid of this 
super-abundance of blood, some outlet was necessary, and 
that this outlet was the uterus. It may be observed, how- 
ever, that in good health, the loss of several times the 
quantity of blood, discharged previous to, or in the very 
act of menstruation, from the arm, or any other part of 
the body, does not prevent or interrupt the flowing of the 
menses. It has been attributed to other causes ; as fermen- 
tation in the uterus ; the power of habit ; some humour 
of the constitution; amorous phlogosis, etc. — none of which 
are satisfactory. Some have regarded it as a simple dis- 
charge of blood, others as a secretion ; some as a consti- 
tutional discharge, and others as merely local. 

Dr. Dewees remarks : — " The final cause of the menses 
is perhaps enveloped in some obscurity ; but of this, we 



52 THE PHYSIOLOGY OF MENSTRUATION. 

know, at least, one incontrovertible fact, namely : that 
the healthy performance of this function, is in some way 
or other connected with impregnation, as no well-attested 
instance is yet upon record, where this has taken place in 
a female who never had had this discharge, or where it 
was not eliminated of a healthy character, and with a 
greater or less degree of regularity." After him, Dr. 
Meigs says : — " What is the proximate cause of the peri- 
odicity, 1 deem it bootless to enquire ; since this, like most 
other vital processes, has a sort of metaphysical subtilty, 
which defies all endeavor to grasp or retain it. 

" Happily, at the present day, we are better informed 
upon the nature of the menses, both in health and in dis- 
ease ; and in so far, at least, better prepared to fulfill our 
duty towards the patient. 

" It seems to be universally admitted that the substan- 
tial causes of menstruation ought to be sough* for in a 
condition of the female ovaries, which are regarded as 
the proper seats of the reproductive faculty, not only as 
being the points in which the aphrodisiac faculty most 
essentially dwells, but as influencing the female constitu- 
tion- in the remarkable manner known to be coincident 
w r ith the development of those bodies, and also consequent 
upon the abstraction of their vital energies after the lapse of 
years. In the male, the full unfolding of the size, form 
and power of the testes, is the sign and guarantee of the 
reproductive force, and the same is true of the ovary of the 
female, in whom, up to the age of puberty, these organs 
are known to be incomplete. 

" The total absence, by congenital deformity, or by 
ablation, or by diseased destruction of both ovaries, is 
known to be attended with the loss of the menstrual power, 
as well as of the erotic principle. The atrophy of the 
same organs, by the progress of age, equally involves the 
abolition of the menstrual force. If these propositions be 
true, it follows that the seat of the menstrual force must 
be conceded to exist in the ovaries." 

Indeed, it is now no longer doubted, that it is not to the 
influence of the uterus, but to the ovaria, that we are to 
attribute all the changes that take place in the female pel- 
vis, in the mammae and uterine system, at the period of 



THE PHYSIOLOGY OF MENSTRUATION. 53 

puberty ; and it seems that it is not improbable, that it is 
also owing to certain changes in the Graafian vesicle at the 
time of menstruation, that all the phenomena of that sin- 
gular process are to be referred. (Negrier.) Dr. Lee 
remarks : — " That the determination of blood which takes 
place to the uterine system every month, and that all the 
phenomena of menstruation, depend upon the ovaria, and 
that at each period a Graafian vesicle bursts and its con- 
tents escape, is rendered extremely probable. " The 
researches- of M. Gendrin have led him, also, to believe 
that the menstrual flux is the result of a periodic conges- 
tion, which takes place every month in the ovaries. 

These explanations enable us to arrive at the nature and 
purpose of menstruation. At each monthly period, a 
small vesicle or ovum is detached from its bed in the ova- 
ria, and passes through the canal of the Fallopian tube, 
into the cavity of the uterus. This contains the rudiments 
of a new being. The same periodic cause which thus 
separates the ovum, at the same time gives rise to the 
menstrual secretion, which washes this egg off through 
the mouth of the uterus — nature not then designing it to 
remain. This vesicle is about the size of a pin's head 
and contains a yolk and membraneous envelopes, as is 
proved by the microscope. 

We shall now see the relation of this discharge, with 
the reproduction of the species. Let it be borne in mind 
that the appearance of it, is the evidence that nature has 
designed, and is now ready, to produce a living and- inde- 
pendent creature. When the conditions of nature have 
been complied with, and conception has taken place, the 
ovum is separated from its bed, as in the menstrual pro- 
cess ; but instead of being washed away, it is, by the pow- 
ers peculiar to this function, retained in the cavity of the 
uterus, where it germinates and becomes a living being. 
The menstrual discharge, now, instead of uselessly passing 
away, is retained for the formation and growth of a mem- 
brane, which envelopes the embryo and passing over the 
mouths of the Fallopian tubes and uterus, effectually 
closing them up, forms a connecting medium between the 
mother and child, for the sustenance of the latter, in a 
way that will be explained in the chapter on pregnancy. 
4 



54 THE THYSIOLOGY OF MENSTRUATION. 

It is proper to remark, that the ovaria of a female 
who has never menstruated, is a soft pulpy mass, oval in 
shape, with a regular, smooth and glistening surface. In 
one who has menstruated — say for ten years — the external 
characters of the ovaria, are much changed ; they are 
seamed and scarred throughout ; instead of the regular 
oval form, we find scars and deep corrugations. These 
changes are in proportion to the length of time the woman 
has menstruated ; when there has been but one menstrua- 
tion, and consequently but one ovum detached, we find but 
one scar, and so on, one in the place of each separated 
ovum. The ovaria of a female who has ceased to indi- 
cate, by the periodic secretion, her ability for fecundation, 
has lost entirely its regular plumpness,, and instead of a 
soft, glistening substance, it is a grisly, withered mass. 

The first issue of the menstruous fluid, is serous ; it 
may be more exactly expressed as sero-sa?igui?ie, which 
becomes more decidedly like blood in the course of a few 
hours, and continues so, till the latter part of the period, 
when it grows paler and paler, until at length it ceases 
entirely, leaving the parts bedewed by their ordinary 
secretions. It has been a question, as we have remarked, 
whether pure blood is discharged ; but at the present day 
the majority of physiologists regard it as a secretion 
resembling blood, but not containing fibrine or the coagu- 
lable principle ; all discharges of coagula being distin- 
guished from proper menstruation, and assigned to abnor- 
mal causes. 

In regard to the opinions of menstruation being a local 
or constitutional discharge, since the late discoveries con- 
cerning it, they are no longer at variance. Every dis- 
charge is local, though its effects must be constitutional. 
It seems, too, more rational, since this discharge is the 
sign of so many changes in the constitution, occurring at 
puberty, to regard it as but the index of a general state 
affecting the whole constitution. This view, alone, ex- 
plains the phenomena of the disorders of menstruation, 
and points to that rational treatment, which is based, not 
solely or mainly in the use of local stimulants, but on reme- 
dies, which, operating on the constitution at large, arouse 
and regulate thor° actions which constitute a function. 






THE TIME OF OCCURRENCE AND QUANTITY. 55 

There has been an opinion, probably derived from the 
Jewish legislator, afterwards adopted by the Arabian phy- 
sicians, and credited in other countries, that the menstru- 
ous fluid possessed some peculiar malignant properties. 
The severe regulations made in some countries for the 
conduct of women at the time of menstruation, the ex- 
pressions used,* the disposal of the blood discharged, or 
of anything contaminated with it ; the complaints of 
women attributed to its retention, and the effects enume- 
rated by grave writers, indicate the most dreadful appre- 
hensions of its baneful influence. We may remark, that 
under peculiar circumstances of health, or states of the 
uterus, or in hot climates, if the evacuation be slowly 
made, the menstruous blood may become more acrimo- 
nious or offensive than the common mass, or any other 
secretion from it ; but in this country and age, no malig- 
nity is suspected ;- the menstruous woman mixes in socie- 
ty, as at all other times, and there is no reason for thinking 
otherwise than that this discharge is of the most inoffen- 
sive nature. (Denman.) 



CHAPTER IV. 

TIME OF OCCURRENCE AND QUANTITY OF THE MENSTRUAL 
DISCHARGE, WITH HYGIENIC RULES FOR MENSTRUOUS 
WOMEN. 

It has already been stated that the appearance of the 
menses in this climate, is observed, at the age of fourteen 
or fifteen years, and that it ceases about the forty-fifth 
year of the individual's age. It will be noticed, that it 
divides the life of the female into three distinct periods : 
the first, that of childhood, exists from birth till the four- 
teenth year ; the second, the most important period, that 
in which she is capable of child-bearing, usually termi- 
nates at about the forty-fifth year; the third is the remain- 
ing portion of life, after she is incapable of fecundity. 
Those who are regular, menstruate every twenty-eight 
days, or thirteen times a year, so that a woman who 

* Isaiah XXX, and Ezekiel. 



56 THE TIME OF OCCURRENCE AND QUANTITY. 

should continue to be regular from the fifteenth to the 
forty-fifth year, would have near four hundred repetitions 
of this function ; or, according to the late theory of men- 
struation, would discharge about four hundred ova or eggs. 

It has also been stated, that the time of the appearance 
of the menses, varies according to a variety of circum- 
stances. We are constantly observing instances in which 
it appears at twelve and thirteen, and even ten years of 
age ; and its appearance is occasionally delayed till the 
seventeenth and twentieth year. In those rare instances 
of discharges resembling menstruation, occurring in ex- 
treme infancy, there is but little approach to the proper 
discharge; they most often depend upon a congestion of 
the genital organs, similarly produced as congestion of the 
lungs in infants and adults, giving rise to a bloody expecto- 
ration from those organs. 

Below, we give a table of Dr. Meigs', upon the authori- 
ty of Drs. Boismont, of Paris, and Lee, of London, show, 
ing the ages at w r hich 1781 women began to menstruate 
in France and England. As the French, and particularly 
the English women, are of similalr temperaments with 
our own, and live in about the same latitude, it is as good 
authority as we can furnish. 

In 1781 women, the menses occurred 
At 11 years, in 110, 
" 12 " " 144, 
" 13 " " 256, 
" 14 " " 360, 
" 15 " " 366, 

Dr. Denman remarks : — " The early or late appearance 
of the menses may depend upon the climate, the constitu- 
tion, the delicacy and hardness of living, and upon the 
manners of those with whom young women converse. In 
Greece, and other hot countries, girls begin to menstruate 
at eight, nine and ten years of age ; but advancing to the 
northern climates, there is a gradual protraction of the 
time, till we come to Lapland, where women do not men- 
struate till they arrive at mature age, and then in small 
quantities, at long intervals, and sometimes only in sum- 
mer. But if they do not menstruate according to the 



At 16 years, in 


284, 


" 18 " " 


144, 


" 19 <• " 


72, 


" 20 " " 


40. 



THE TIME OF OCCURRENCE AND QUANTITY. 57 

genius of the country, it is said they suffer equal incon- 
venience as in warmer climates, where the quantity dis- 
charged is much greater, and the period shorter. 

" In this country, (England) girls begin to menstruate 
from the fourteenth to the eighteenth years of their age, 
and sometimes at a later period, without any signs of dis- 
ease ; but if they are of delicate constitution, and luxuri- 
ously educated, sleeping upon down beds, and sitting in 
hot rooms, menstruation usually commences at a more 
early period." 

Linnaeus remarks that he saw women in Lapland who 
menstruated only once a year. M. Lisfrank has met with 
women who were " regular" every fifth or six month, and 
others only every fourth, and even sixth year — some of 
whom enjoyed good health. Many women are met with 
who, in all other respects, are in fine health, yet in whom 
the periodical returns anticipate as regards the lunar 
months. Thus, certain nervous women, especially such 
as are of an erotic temperament, are found to menstruate 
every fortnight, while others, of an opposite constitution, 
are subject to the returns only every six weeks, or even 
only every two months. Occasionally, women who have 
been regular till that time cease to menstruate at the age 
of thirty-five, or thereabouts, and have a return again of 
the discharge after the lapse of five or ten years. 

In general, a warm climate favors the early appearance 
of the menses. Haller mentions the case of a girl in the 
Alpine valley of Emmenthal, who was delivered of a 
child at her ninth year ; and cites examples of the erup- 
tion of the menses at birth, at three months, at four months, 
the second year, the third, fourth, fifth, sixth, seventh, 
eighth, ninth and tenth year ; and says that he was daily 
in the habit of seeing a noble lady, of great beauty and 
wit, who was then in her ninth year, and who had men- 
struated regularly for some years past, without any injury 
to her health. She was very small and delicate. The 
rule, however, of precocious menstruation is not invaria- 
ble for warm climates, since the young females of the 
banks of the Senegal are regular at the same epochs with 
those of the young persons at Paris or Philadelphia. The 

D 



58 THE TIME OF OCCURRENCE AND QUANTITY. 

instances mentioned, occurred mostly in certain distin- 
guished and luxurious families. (Meigs.) 

The quantity discharged at each menstrual period, 
depends upon the climate, constitution and manner of 
living ; but it varies in different women in the same cli- 
mate, or, in the same women at different periods. In this 
country, the usual amount is five or six ounces. It is 
well for the female to understand, however, that it may be 
very much less or considerably, more ; each one having 
a rate of her own from which she rarely varies, and it 
might be said never, unless some circumstance may have 
interfered with her health. It seems that this function 
differs as much as some others — such as the required 
amount of food, sleep, etc. 

Hippocrates thought that the Greek women lost twenty 
ounces at each menstruation. Galen estimated it at eigh- 
teen ounces. Haller computed it at six, eight, or twelve 
ounces for the German women. According to Smellie 
it amounts to four ounces in England. Astruc says that 
it varies from eight to ten ounces among the French 
women. Magendie thinks it is often very great and may 
amount to several pounds. The difficulty of collecting 
the menstrual blood, and the numerous variations in the 
amount of the discharge, have necessarily occasioned 
the differences of reports by the observers whose names 
are here mentioned. (Colombat.) 

Among our own country-women, there would undoubt- 
edly be far more uniformity in the appearance and quan- 
tity of this fluid, and in its effect on the constitution, could 
females arrive to the period of puberty under more favora- 
ble influences than at present surround them. 

In health, the menses return with surprising regularity ; 
a great majority of women expect it with the utmost con- 
fidence for a certain day of the week or month, and accord- 
ingly make preparations for its reception, frequently modi- 
fying their arrangements of business or pleasure by its 
indications ; for it should be remarked that the discharge, 
in a good many subjects, appears suddenly, and is quite 
free from the first moment, whereas in general it com- 
mences by slow degrees, increasing in abundance at the 
end of the first day, and declining on the last. 



HYGIENIC RULES FOR MENSTRUOUS WOMEN. 59 

Menstruation may be regarded as one of the most im- 
portant epochs in the life of a female ; should it not be 
established, all the charms of her person disappear, and she 
is subjected to despondency, and a long train of lamentable 
evils. Therefore, the attention of a mother should be 
fixed upon this period, with a degree of interest due to 
one who stands in such an endearing relation as that of 
a daughter. Dr. Colombat's remarks are so well adapted 
to illustrate these consequences and the means of avoiding 
them, that we shall close this chapter by transferring the 
substence of them. 

From the first appearance of the menses, until the term 
when they are to cease by the lapse of years, her health, 
her freshness and her beauty depend upon the regular 
return of this sanguine evacuation. Those who experi- 
ence no menstrual revolution, are rarely fruitful, and its 
sudden suppression in youth and in health, is one of the 
least deceptive signs of conception. 

When the periodical evacuation meets with obstacles, 
and nature makes vain efforts to establish it, all the pow- 
ers of life diminish or become perverted ; and trouble and 
disorder among the functions throw a speedy veil over the 
brilliancy of the maiden. A crowd of symptoms often come 
to aggravate this dull languor; the respiration becomes 
difficult, the circulation languishes, the tastes and appe- 
tite are perverted, depraved, the feet and limbs begin 
to swell, the eyelids to be tumid, the face is bloated, and 
acquires a sallow hue, or a greenish or chalky tint ; at 
length painful palpitations, frequent faintings, a deep-felt 
anxiety, distress, weakness of the senses, a certain indo- 
lency, and a weariness which renders every motion disa- 
greeable — come to obscure this sad and afflicting picture. 
When we come to speak of the derangements of this 
function in their proper places we shall treat more fully 
of this condition and of the modes of obviating it. 

HYGIENIC RULES FOR MENSTRUOUS WOMEN. 

From the period of puberty to the critical age, the men- 
strual discharge requires certain cares and precautions, 
which it is important to understand. While the flow is 



60 HYGIENIC RULES FOR MENSTRU0US WOMEN, 

present, women ought to refrain from taking cold baths, 
and from washing the hands and genital organs in cold 
water; they should, also, avoid cold feet; they should 
not remain with the arms or neck uncovered, and must 
abstain from iced, exciting and alcoholic drinks — such as 
wines, coffee, tea, liquors, etc.; marital connexion, also, 
ought to be proscribed, because the excitement determined 
by it in the genital organs, may occasion either monor- 
rhagia, or more or less complete suppression, and seconda- 
rily a utero-vaginal inflammation. It is well, also, to avoid 
sitting upon cold and damp places, for example, the earth, 
a stone bench, a grassy bank, etc. 

The napkins employed to receive the fluid of the men- 
ses, as it escapes from the genital parts, ought always to 
be well aired, and in winter, warmed before being ap- 
plied. If the discharge be too abundant, it may be reme- 
died by a vegetable and milk diet ; by repose ; by the hori- 
zontal position ; by cooling and sedative drinks, as weak 
lemonade, barley water, whey, etc; if the female be of 
lymphatic temperament, she must use, on the contrary, a 
tonic diet, composed chiefly of roast meats, feculent sub- 
stances, and rich soups. When menstruation is entirely 
or partially suppressed, in consequence of some impru- 
dence or unexpected occurrence, it is necessary to en- 
deavor to recall it, by means of warm infusions of balm, 
etc. Rest in bed, warmth to the thighs and legs, main- 
tained by bottles filled with warm water, are other means 
which should not be neglected. 

We ought to remark, moreover, that during the flow of 
the menses, except some absolute necessity arises, it is 
proper to abstain from the use of bleeding, of purgatives, 
of emetics, and all those remedial means which act ener- 
getically, and which might occasion an impression capable 
of disturbing the salutary efforts of nature. In general, 
women may escape most of the disorders of menstruation, 
either by exercising, to a greater extent, the muscular 
system, which they too often condemn to dangerous inac- 
tion ; by abstaining from exciting, salted, or highly-sea- 
soned food, and from stimulating drinks ; or, lastly, by 
taking care to clothe themselves suitably during the winter; 
and es)ecially by wearing flannel drawers, some days 



IMPERFECT PUBERTY CAUSES. 61 

before, and during the epoch of the menses, principally. 
It is, likewise, very important that they should abstain, 
durino- the presence of the discharge, from all intellectual 
labors, and from severe study, which, by establishing a 
hi^h cerebral excitement, determine an unequal distribu- 
tion of the vital forces, and cause an afflux towards the 
brain of the blood w^hich ought to flow towards the genital 
apparatus. 

Before concluding what we had to say upon the atten- 
tion to hygiene that menstruation requires, we will add, 
that so long as the function lasts, women ought to be the 
object of the most attentive kindness, and of a solicitude 
capable of preserving them, as far as possible, from the 
unhappy influences of the physical and moral causes 
which affect them then more strongly than at any other 
period. It is well to say, also, that if some amongst them 
become subject, at these periods, to caprices, to sadness, 
and unequal temper, we should always bear these transcient 
humors with indulgence, because they depend upon the 
action of the body upon the mind, and upon an active irri- 
tation, which is radiated from the uterus towards the other 
organs, and especially towards the brain. 



CHAPTER V. 

IMPERFECT PUBERTY, WITH THE CAUSES ^AND TREAT3IENT OF 
PRECOCIOUS MENSTRUATION. 

The late important discoveries concerning menstruation, 
establish beyond a doubt, that the proper and healthy 
appearance of the function, depends upon the maturity 
of the constitution in infancy and childhood. It is no 
longer doubted, that this discharge, instead of being 
merely a passive exudation, dependent upon local causes, 
is the result of a general state of the female constitution ; 
it is the external sign of a function, the development of 
which, influences largely the whole organism. We have 
already, in another place, remarked that this view of the 
function is important, as it alone explains the phenomena 



62 IMPERFECT PUBERTY CAUSES. 

of deranged menstruation. It is vastly more important, 
from the fact that it points to a more rational mode of 
treatment than hitherto has been pursued ; which, instead 
of being based upon the use of local stimulants, specific 
drugs, etc., depends upon the exhibition of those remedies 
which, operating on the constitution at large, arouse and 
invigorate the whole of its numerous functions. Indeed, 
it is now conclusively proved, that nearly all that has here- 
tofore been supposed to have been affected by the agency 
of such stimulating remedies as have been used, if pro- 
ductive of seeming good to the individual, that the amend- 
ment was in reality owing to the efforts of nature produc- 
ing constitutional changes at the period when the medicine 
was given. 

We have already spoken of the constitutional changes 
which occur at the period of puberty. It is evident,, from 
infancy, that nature has some grand object in view ; all 
her powers seem to be put in requisition for the growth 
of the body. The child laughs and skips away its early 
years, without anything remarkable occurring till the 
approach of puberty, when suddenly there are signs of a 
higher vitality, and often before we are aware of the 
change — instead of the child, we observe in its place a 
woman. Great changes are now observable in the whole • 
frame ; the nervous system in particular, acquires addi- 
tional capacity of emotion and passion, and the imagina- 
tion is in an especial manner developed. The lower part 
of the brain becomes very much enlarged ; the blood is 
attracted to the upper and lower portions of the trunk, 
subserving to those rapid developments peculiar to the 
female. The ovaria become red and enlarged ; the Fal- 
lopian tubes, with their fimbria, are elongated, erectile and 
irritable ; the uterus has acquired size, and a more san- 
guine hue — and the hips, pelvic organs, and mamma, are 
enlarged. The organs *of the chest participate in the 
effects of that action, and even the limbs acquire the forms 
of a maturer development. The intensity of vitality is 
such, and so complete is the resistance of the frame, at 
puberty, in the conflict against disease, that the mortality 
of our species, is least in this portion of our life. 

On the other hand, the whole body suffers when the 



IMPERFECT PUBERTV CAUSES. 63 

internal organs of generation are undeveloped ; the mind 
is dull, and the emotions and passions depressed or absent ; 
the muscular system is imperfect ; the mamma are with- 
ered, the lungs are scantily developed, and not only is 
life less intense, but less long ; and often, early consump- 
tion soon puts a period to the working of so faulty an 
organism. 

A distinguished French physician remarks : " Various 
causes, calculated to render the play of the vital forces 
more active, have the effect either of retarding or precipi- 
tating the age of puberty; thus, abundant and stimulating 
food and drinks, manners, habits and climate, exercise a 
marked influence upon this vital phenomenon. 

"Certain moral circumstances may, likewise, accelerate 
its arrival ; but the artificial maturity thus resulting 
always acts injuriously upon the organization. Among 
these circumstances may be enumerated premature pas- 
sions and pleasures, the arts of imitation, music, painting, 
the perusal of obscene romances, the inspection of lascivi- 
ous pictures, the theatre and ball-room ; the bad examples 
of premature libertinism, of which too many examples . 
are unfortunately furnished in great cities. The speci- 
mens of premature puberty, the miserable consequences 
of too great vivacity of the imagination, are sometim'es 
met with as early as the eighth or tenth year." 

We should consider ourselves highly culpable, notwith- 
standing we may shock the prejudices of the reader, did 
we neglect, in this place, to point out a most prominent 
cause of precocious puberty in young femares. Other 
writers upon these matters, from various causes— perhaps 
a principal one is, the unpopularity of the subject — have 
neglected to speak of it ; but when we see the health of 
thousands- of our youth around us, being sacrificed to 
its shrine, and observe that mystery only adds to its power, 
the subject is no longer to be avoided. We cannot be 
misunderstood : we refer to the calamitous and degrading 
vice of artificial indulgence ; it has, also, been called ?nas- 
turbation, solitary vice, and received other names, which 
signify a self-abuse, practiced by the youth of both sexes, 
to an alarming extent. This evil has been the occasion 
of several medica] convocations at Paris, for the purpose 



64 IMPERFECT PUBERTY CAUSES. 

of proposing means of remedying it ; but their efforts 
proved almost useless, as they made a mystery of the 
matter, instead of making it public as they should have 
done. This habit is commenced by some at a very early 
age, and has undoubtedly, in many instances, been com- 
municated by titillation to infants by ignorant and vicious 
nurses, for the purpose of quieting them. It exists in 
boarding schools and other public institutions to an alarm- 
ing extent, as well as in private life. 

It will be inferred from the foregoing, that this abuse is 
a very great evil. It is not only the cause of the forma- 
tion of a precouious temperament in the young female, 
and thus unfitting her for the marital relation and bearing a 
healthy offspring, but it is the source of numerous diseases 
too painful to relate. In speaking of such indiscretion in 
both sexes, Dr. Boerhaave remarks : " It causes convul- 
sions, emaciation, and pain in the membranes of the brain ; 
it deadens the senses, particularly the sight ; gives rise 
to dorsal consumption, and various other mental and bodily 
disorders." 

We have no room for enlarging upon this subject. 
Parents are delicate in speaking of it to their children ; 
though sometimes they are ignorant of its effects, and have 
been themselves sufferers by it. Need we say that it is 
better to warn a child against such demoralizing practices 
and save his health, nay, his very reason, than to remain 
silent from motives of a most absurd modesty, and let him 
pursue his ruin, unconscious that he is doing anything 
wrong ? 

It has been mentioned by several authors, and we will 
give a case in illustration from our countryman, Dr. 
Dewees, that there seems to be some connection between 
precocious menstruation and scrofulous affections of the 
spine. It was the case of a young lady twelve years of 
age, laboring under a diseased spine. She was afflicted 
with headaches, sickness of stomach, and had at periods 
pain in the small ot the back, with bearing down sensa- 
tions, etc. It was concluded that an effort was making 
for the production of the menses, though the common 
signs of puberty were mostly wanting. Upon examina- 
tion by the mother, of her linen, it was ascertained that 



IMPERFECT PUBERTY— CAUSES. 65 

there was a discharge from the vagina, resembling leu- 
corrhea ; this was observed for four periods, after Which, 
the menses, with their usual appearances, were established. 

It seems from this and similar cases, that ulceration and 
curvature of the spinal bones may be produced by the 
same causes — precocious indigencies, highly spiced food, 
etc. — which give rise to premature menstruation. We 
shall find on examination of the diseased spines of young 
females, where disorganization of the bones has taken 
place, that the menses are always more or less deranged, 
and in the latter stages of the disease, that they have 
entirely disappeared. This sad affection, with its long 
train of melancholy results, can only be prevented by 
early management, so as to produce a healthy childhood. 

We have sufficiently numerous examples of precocious 
puberty, to establish the following general conclusion: — 
1. The signs of puberty may become visible at any 
period commencing shortly after birth, and extending up 
to the ordinary time of the regular development of that 
function (menstruation). 2. The majority of cases ex- 
hibit these signs in the third year. 3. The frame, in gene- 
ral, participates but partially in the impulse given to the 
sexual development ; the growth of the rest of the body 
never being on a par with that of the sexual organs. 
4. The internal organs retain the type and textures of an 
early age, and soon exhibit the signs of premature decay ; 
the ovaria are frequently diseased ; the external organs 
are rarely harmoniously developed ; the limbs are very 
short compared with the trunk. 5. The mental faculties 
are in most instances obtuse ; nay, even deficient. 6. The 
individuals are short lived. (Furguson.) 

The same causes, which in some constitutions produce 
precocious puberty, in others embarrass the organism so 
much as to give rise to the imperfect development 
and consequently late appearance of the menstrual dis- 
charge. So that hereafter, when having occasion to refer 
to them, we shall speak of these causes under the same 
head. They are hot rooms; sedentary habits and a luxu- 
rious life ; much and early excitement of the brain and 
emotions ; irritation of the sexual organs, from masturba- 
tion or artificial indulgences, etc.. etc. 



66 IMPERFECT PUBERTY TREATMENT. 






The woman-infant, so to speak, pines and wastes under 
irritative fever, marked by a rapid pulse, much wearious- 
ness, disturbed sleep, copious perspiration, languor of 
body and dullness of mind, symptoms which are more 
intense just before and just after menstruation. 

The indications for treatment, are, during the period, 
absolute repose in the horizontal posture. After this is 
over, all those remedies should be resorted to which are 
useful in certain fornis of Menorrhagia (see that chapter); 
those which repress the local action ; and all those means 
elsewhere enumerated which invigorate the languid frame. 
At the same time the faulty education of mind and body 
must be remedied. 

From what we have already said upon this subject, the 
reader will understand that healthy menstruation is only 
compatible with a good constitution ; that the developing 
and sustaining of this function, require the action of the 
constitutional powers in all their plentitude of vigor ; that 
nature, unembarrassed by art, and the carelessness of the 
female, is able, by her own silent forces, to attain her 
grand object, viz : the perfect development of the ovaria 
upon which menstruation depends. 

" No one suspects that medicine exerts any influence in 
producing menstruation in those countless thousands of 
cases, that occur in classes of society where no solicitude 
is awakened — where the female each day arises, and after 
a hasty, and perhaps insufficient meal, commences her 
labors, often continued into the proper hours of sleep. 
Here every circumstance that can exercise a tendency to 
hinder the attainment of the great end, is brought into 
action ; and amidst all sorts of depressing influences, the 
young female at length becomes regular. It is thus evi- 
dent that nature is all powerful ; she means to compass 
her purposes, and no slight circumstance will prevent it. 

" Now suppose any of the exhausting causes wa have 
enumerated, are brought to bear upon a young girl ; sup- 
pose her nervous system to be constantly taxed by too 
much excitement of stimulating food, spices, wine, etc., 
her body dibilitated by excessive quantities of clothing, 
perhaps ill-made, and impeding the healthful expansion of 



IMPERFECT PUBERTY — TREATMENT. 67 

the lungs ; whilst she is severely taxed by the absurd 
requisitions of a school mistress, depriving her of a 
healthful exercise, at a period of life when she most 
requires it — the inevitable result will be, that the blood, 
instead of an equal distribution ove^r the surface of the 
body, will be thrown upon the internal organs, and it will 
most certainly go, in increased quantity, to those most im- 
mediately intended to be brought forward by nature. A 
premature establishment of the menses is the consequence; 
and the pale and sickly plant, (grown under the influence 
of too much heat and water, and too little light,) is but an 
emblem of the young female. In neither have the requi- 
sitions of nature been fulfilled ; and both present the same 
consequences, viz : great exhaustion and debility, that can 
only be overcome by a careful attention to nature's de- 
mands. 

u The class of medicines called tonics, in judicious hands, 
may aid her restoration ; but they never can eilect it with- 
out carefully retracing and remedying, as far as possible, 
the errors of early life. Nutritious and unstimulating 
food, free exercise in the open air, with a hearty enjoy- 
ment of all innocent recreation, should be the means 
chiefly relied upon. How far medicines of the tonic class 
shall be used, can only depend upon the intelligent and 
thoughtful physician, whose aid it is supposed will always 
be requested by the mother. 

" Most probably, the poor child is under the daily influ- 
ence of a doating and fashionable mother, who has called 
to her aid all the appliances of our modern system of edu- 
cation. With the eloquent example of all animated na- 
ture before her, the feathered and brute tribes, aided by 
unrestrained freedom of motion, natural food, fresh air, 
and healthful sleep, carrying out the plan of their own 
being, and exciting the envy of the poor invalid — she, 
alas ! is subjected to the irksome discipline of the school- 
room, with its repulsive and dry details, and too often its 
daily jargon of sound-without sense ; her body clothed with 
iasbionable garments, the preservation of which seems the 
most important object of her life; whilst every free and 
healthful movement is restrained, and everv natural im- 



68 IMPERFECT PUBERTY — TREATMENT. 

pulse checked, because it over-steps some absurd idea of 
gentility. 

" It is impossible, if we are to convey any correct idea 
of the healthful establishment of menstruation, to avoid 
constant reference to .tight dress, and deficient exercise. 
Our conviction that these, with ill-chosen food, and some 
other evils of temperament entailed upon their offspring 
by the unmanageable passions of parents, impressing their 
own systems with disease, and thus conveying it to their 
children, is so strong, and our belief that we should resort 
to natural means for cure, and not to medicine, so conclu- 
sive, that if we recur again to this subject, the reader 
must impute it entirely to a sincere desire to aid her in 
her endeavors to benefit her child, and not to carry out 
any hypothesis of our own. 

" The administration of some of the more gentle medi- 
cines may become necessary from the impossibility of im- 
mediately regulating the regimen of the patient ; and we 
do not object to their use with the view of putting the body 
as soon as possible in a condition to dispense with them. It 
is the use of stimulating and specific drugs that we 
deplore; such as are intended to force nature. This they 
can never do, without inflicting great injury upon the deli- 
cate lining membrane of the stomach and bowels, for on 
that is their action first expended, before they can possibly 
affect the ovaria. Moreover, they are often given before 
nature presents any evidence of personal development, 
and whilst the evolution of the ovaria is going on with 
all the certainty and speed intended for the peculiar indi- 
vidual. " 

We have made these copious extracts from Dr. Dixon, 
for the purpose of impressing more fully upon the mind 
of the female, that in these cases, but little reliance can be 
placed upon medicine. It is exceedingly important that 
the reader understand this fact ; if she be suffering, or 
if her child be suffering, under maternal care, she impor- 
tunes the physician for medicine, imagining that this will 
be a restorative of health — without ever taking into con- 
sideration those causes that we have enumerated, which 
have produced a too early development of puberty ! Un- 
der these circumstances, it will be a great misfortune to 



GENERAL HYGIENE FOR FEMALES. 69 

the patient, if the physician employed be one who practi- 
ces his profession solely as the means of acquiring wealth, 
combined, as this disposition often is, with deficient quali- 
fications. 

The physician above named mentions a case wherekx 
the mother importunately demanded medical treatment for 
her child, who possessed not a single sign of womanhood ; 
and on his refusal to prescribe, death was the consequence, 
from the use of a powerful medicine (probably a quack me- 
dicine of the day) administered by a well-meaning but 
ignorant parent. He remarks : " The case made, at the 
time, a strong impression upon our sympathies, and we 
determined to use our humble powers of popular instruc- 
tion, when time and experience had given us more know- 
ledge of the subject." From this, it will be seen that the 
educated and prudent physician prescribes from a know- 
ledge of the properties of medicines ; and that no unquali- 
fied person should attempt to modify his treatment. In the 
pages devoted to the consideration of deranged menstrua- 
tion, will be found the most approved medical treatment, 
when any is necessary, for disorders of this function, 
which, of course, should only be applied under the direc- 
tion of a competent physician. 



CHAPTER VI. 

GENERAL HYGIENE FOR FEMALES, BIT WHICH THEY MAY SE- 
CURE TO THEMSELVES HEALTH AND PERSONAL BEAUTY. 

Medicine as a developing agent, it will have been ob- 
served, is of little or no avail in effecting the maturity 
of the bodily functions. We do not now speak of it as a 
curative agent, for it is obvious that when certain derange- 
ments and obstructions already exist, the judicious employ- 
ment of medicines adapted to the case, will put the body 
in a favorable condition for nature to act, when regimen 
may take the place of it. We have heretofore spoken of 
the special causes that produce premature decay and pros- 
tration of the constitutional functions, and of the restorative 
4* 



-"solitude, sad nurse of care, 

To sickly musing gives the pensive mind." 

We shall now proceed to review, in regular succession, 
(that we may not avoid important omissions,) the several 
classes of circumstances which constitute hygiene, accord- 
ing to the method of Dr. Colombat, whose writings upon this 



TO GENENAL HYGIENE FOR FEMALES. 

power of hygiene, a well regulated diet, exercise, etc. It 
is now proper, in a more extended view, to notice the pe- 
culiar modifications of general hygiene, necessary, in its 
application to the female. 

It is ill- ventilation, improper clothing, and want of clean- 
liness ; ill-feeding and drinking; over work and want of 
exercise ; mental calamities and passions of the mind ; 
excessive indulgences, etc., which rob life of its maturity 
and bring a long train of evils to the sufferer ; some of 
these are known as nervous debility, dyspepsia, and bil- 
ious difficulties, all of which are more or less in the power 
of the individual to avoid, were she instructed in the laws 
of physical organization. 

It is evident that obedience to the physiological laws is 
necessary in order to secure an existence free from pain. 
For instance, the lungs must be supplied with a sufficiency 
of that element, unadulterated and unviciated, which has 
been designed by nature for their use. The skin must be 
cleansed from those impurities which are constantly 
collecting upon it. The digestive organs must be fur- 
nished with their proper quantity and quality of food and 
drink. The muscles of every part of the body must be 
brought into frequent and active exercise, by proper em- 
ployment, or vigorous diversion. The exhausted powers 
of the whole physical organization, must be recruited and 
refreshed by suitable intervals devoted to " tired nature's 
sweet restorer," unconscious sleep. And as Dr. Arm- 
strong says : — 

" 'Tis the great art of life to manage well 
The restless mind." 

It must not be too much engaged in the pursuit of know- 
ledge, nor entirely unemployed; for 



GENERAL HYGIENE FOR FEMALES CIRCUMFUSA. 71 

subject, we shall freely avail ourselves of, they beiLg so 
well adapted to our present purpose ; indeed, the following 
remarks are extracted from his work with very little change. 

1. ClRCUMFUSA, OR SURROUNDING CIRCUMSTANCES. If 

it be true, as the sage of Cos observes, that air is the ali- 
ment, the pabulum of life, it also hapens that it may be- 
come the aliment or cause of death, in the disorder of 
which it is frequently known to be the pernicious cause. 
As women are by nature more sensitive and impressiona- 
ble, and possess smaller lungs, that are more irritable, 
and more liable to phthisis, they are of course more injuri- 
ously affected than men are by the influence of atmospheric 
vicissitudes. Precautions in regard to the respiratory or- 
gans deserve, in an especial manner, to fix our most particu- 
lar attention at the approach to puberty, during the act of 
menstruation, at the change of life, and in fact, at all the 
epochs of the life of the female that are characterised by 
an increase of the general susceptibility. 

Women, particularly those in whom luxury and ease 
have given additional acuteness to their impressionability, 
ought, as far as possible, to inhabit elevated apartments ; 
they should avoid crowded saloons, where the air is both 
too hot and unwholesome ; they should be particularly care- 
ful not to pass carelessly from a high to a low tempera- 
ture ; when compelled to do so, or to remain for sometime 
with a part of the person unprotected, they might greatly 
lessen the risk of injury from sudden transition of tempera- 
ture and from the pernicious tendency of sudden cold, by 
stopping for a while in a cooler apartment, or by keeping 
up an artificial warmth, by walking or any other brisk 
motion. Those who are of a delicate constitution and 
prone to catarrhal and tuberculous disorders, would act 
very wisely in rendering their parenchymatous organs and 
their whole mucous system, and especially the bronchial 
and genital mucous membranes, less impressionable by 
keeping up a gentle excitement on the skin, by wearing 
flannel jackets and drawers ; they may, also, weaken the 
evil powers of dampness and cold, by using mild tonic 
drinks, and food both nutritious and easy of digestion. 

The. changes that the constitution of the air may under- 



72 GENERAL HYGIENE FOR FEMALES CIRCUMFUSA. 

go are sometimes extremely hurtful, especially to women. 
They ought, as far as possible, to interdict for themselves 
all places of resort where great numbers are assembled, 
such as balls, shows, concerts, etc. Without dwelling in 
extenso upon the effects of exhalations and gaseous efflu- 
via, we shall be satisfied with saying, that the habit in- 
dulged in by some females of surrounding themselves with 
odors, deserves to be mentioned, on account of the acci- 
dents and the real danger which accompany such habits. 
Nervous persons should, therefore, not only shun the im- 
pression of powerful odors, and perfumes, even the most 
delicate, but they ought not to have in their chambers 
flower-pots and vases filled with flowers, which are attend- 
ed with the double inconvenience of affecting the nervous 
sensibility too powerfully, and of decomposing the air by 
the exhalations of carbonic acid gas. 

Among the numerous cases in point, that we have it in 
our power to cite, we shall confine ourselves to the case 
related by Cromer— that of the daughter of Nicholas I., 
who died after having inhaled the odor of a rose. In 
1774, a woman in London was found dead in her bed, in 
consequence of having breathed the odor of several full- 
blown lilies that she had placed in a small chamber. 
Triller, saw a violet give rise to a distressing accident ; 
under nearly similar circumstances, the emanations from 
some lilies in blossom very nearly proved fatal to the wife 
of Sanmonier, the distinguished Rouen surgeon. Lastly, 
on the night of the tenth of August, 1837, the Duchess 
d'Ab***, was upon the point of being asphyxiated from 
having slept several hours in her bed-room, where her 
friends and the admirers of her literary talents had deposit- 
ed their presents of flowers on the eve of her birth-day. 

From the facts above related, it is easy to judge that 
women ought to abstain from perfuming their apartments 
with flowers, essences of oriental pastilles, and from carry, 
ing about their persous, perfumery and sweet scented 
bags, which are capable not only of powerfully affecting 
the nervous sensibility, but even acting as the occasional 
cause of syncope, of asphyxia, and a variety of spasmodic 
disorders, to which the sex are peculiarly prone. 

Let us add that the abuse of perfumes is attended with 



GENERAL HYGIENE FOR WOMEN APPLICATA. 73 

the objection that it may exalt or depress the power of 
the sense of smelling, and that Montaigne has judici- 
ously remarked, " que la plus exquise senteur d'une femme y 
c'est de ne rien sentir " bene olet qua nihil olet. 

Among the most mischievous habits indulged in by 
females, we ought to signalise the use of foot-stoves, 
which disengage a quantity of carbonic gas, and, likewise, 
excite the genital organs and predispose to fluor albus, 
and uterine hemorrhage, to piles, varix, ulcers on the 
legs, etc. Persons whose avocations expose their feet to 
cold, would do well to substitute for the foot-stove a small 
box, lined with bear skin, to put the feet in, or a tin vase 
filled with hot water. 

2. APPLICATA, OR THINGS APPLIED TO THE SURFACE OF 
THE BODY* CLOTHING, CLEANLINESS, COSMETICS, ETC. In- 

asmuch as there is attached to our clothing, the precious 
advantage of guarding the body from the immediate im- 
pression of the atmosphere, and thus of annulling, to a 
certain extent, the influences of atmospherical vicissitudes, 
it is very important that all parts of the female dress 
should be constructed with reference to their manner of 
life, the circumstances in which they are placed, and the 
prevailing temperature of the air. In winter, they should 
wear woollen stuffs, or silken stuffs wadded, or double, 
which, while they are both supple and light, yet keep up 
a good degree of warmth about the person, from their 
being bad conductors of caloric. Although furs are pos- 
sessed of the same property, they are inconvenient, be- 
cause upon leaving them off, merely for a short time, the 
person becomes sensible of the slightest cold. In summer, 
they should make use of linen or hemp ; whereas, in the 
fall and spring, the variableness of the season requires the 
use of dresses that are moderately warm. Lastly, at all 
seasons of the year, females ought not, without great care, 
to lessen the number of their garments, or suddenly change 
them for others, less preservative against the sudden 
changes of weather. It is equally important for them, at 
all times and seasons, to keep the bosom and the arms 
covered, and most especially is it important, during the 
act of menstruation. 



74 GENERAL HYGIENE FOR WOMEN APPLICATA. 

The form of the female dress, also, deserves attention ; 
it should always be large enough not to interfere with a per- 
fect freedom of motion, and not to exert any compressing 
power on the several parts of the body ; the corset, especial- 
ly when badly constructed, or too tight, interferes with the 
motions of the body, prevents the expansion of the lungs, 
and favors a stagnation of blood, in the internal parts of 
the body, disposing them to be attacked with imflammation, 
and in consequence thereof, with consumption. Moreover, 
they painfully compress the breasts, and act as causes of 
cancerous engorgements and indurations. It is but just, 
however, to state, while the corset, when too small, too 
tight, and supplied with strong whale-bone and a steel 
busk, is almost always hurtful, the elastic corset, well- 
fitted to the shape, furnished with ample gussets to receive 
the breasts, without compressing them, and besides, unpro- 
vided with the busk, and applied moderately tight, lends 
grace to the figure, gives a useful support to the bosom, 
increases the energy of the muscles on the chest and ab- 
domen, and, in fine, obviates a disposition to divide, met 
with in some of the muscles, prevents the escape of the 
abdominal viscera from the cavity of the belly, as well as 
the deviations of the womb, in pregnant and lying-in 
women. It should be said, furthermore, that a corset, 
when well made, ought to adapt itself to the hips and other 
parts of the body, and not these latter to the corset, as the • 
fashions often require. 

The use of whale-bones, far from being injurious, in all 
cases, as most authors consider them, is, on the contrary, 
useful, provided they be made very thin and flexible ; for 
they prevent the numerous folds that the various motions 
of the wearer would make in the corsets, and which, as 
well as the pain that attends them, could be no otherwise 
prevented than by making the corset fit much tighter 
than when provided with whale-bones. It should be re- 
marked, also, that the shoulder peices ought to be very 
large, and especially very elastic ; but that, although we 
recommend to full-grown women the use of a corset not 
too tight, we look upon their use, before the age of puberty, 
as very hurtful. 

Frequent changes of clean linen, and strict attention to 



GENERAL HYGIENE FOR WOMEN APPLICATA. 75 

cleanliness, deserve the most scrupulous attention of the 
female ; she ought to take a tepid bath at least once a 
rnonthj,4he effect of it being to cleanse the skin, render it 
supple, promote the peripheral circulation, excite perspira- 
tion, and thus assist nature in one of her proposed ends. 
The temperature of the bath ought to be so adjusted as to 
excite neither a sensation of heat nor cold ; it should sim- 
ply be agreeable. This last is always to be preferred to 
that of the thermometer, which, although it does indicate 
the temperature of the water, yet it does not indicate what 
may happen to suit the state of the bather. River or sea 
bathing, in the summer season, most generally agrees 
with the constitution of the sex ; but hip-baths, which 
tend to produce a congestion of the pelvic viscera, should 
not be allowed, except under some special indication, of 
which a skilful physician is the most fitting judge. 

Among the attentions to cleanliness, we ought to place 
in the first rank, those that refer to the cure of the sexual 
parts. The only liquid a woman ought to use for her 
toilet, at all seasons of the year, except winter, is fresh 
water ; in the winter season, it ought to be tepid, that is, 
it should be made as warm as it is in the summer season. 
Very cold water might produce inflammation of the vagino- 
uterine mucous membrane, and thus bring on the whites ; 
whereas, the frequent employment of tepid water is attend- 
ed with the risk of relaxing the genital organs, and giving 
them a disposition to be affected with hemorrhage. 

For the purpose of injecting the vagina, it is best to 
make use of a syringe, with a curved canuia ending in 
an olive, with several holes in it ; by such an arrangement 
of the canuia, the woman is not subject to too violent an 
impulsion of the liquid against the mouth of the uterus. 
It is just to state, moreover, that all those toilet vinegars, 
those essences, the astringent compositions, and all those 
mysterious waters that the perfumers have the talent to 
produce, under a variety of picturesque titles, should be 
proscribed by females who attach any importance to the 
conservation of their health ; it is, at the same time, useful 
for them to know, that certain preparations invented by the 
corruption of the public manners, and which are the occa- 



76 GENERAL HYGIENE FOR WOMEN— APPLICATA. 

sional resources of mere libertinism, are far from equal- 
ing the precious character of true innocence. 

A desire to please, and to conquer all hearts by her 
beauty, has, in all countries and in all ages, been one of 
the most important occupations in the life of the female; 
to attain this end, her imagination, fruitful in inventions 
of the sort, has suggested to her various means, in the 
first rank of which, is the cosmetic. These articles which, 
as their name shows, are designed to embellish the skin, 
have fallen into the hands of a set of charlatans, who have 
transformed them into a thousand shapes, more or less 
prejudicial to the health, and always useless, " pour repa- 
rer des ans V irreparable outrage" 

If there really are any cosmetics, which are unattended 
with injurious effects upon the skin, such as the aromatic 
distilled waters, etc., the greater proportion of them, especi- 
ally the different sorts of rouge, and among others, the red 
and the white, compounded of the metalic preparations, 
such as lead, mercury, antimony, bismuth, arsenic, etc., 
etc., are extremely hurtful, and are, at the present day, 
wholly abandoned to the use of players, courtesans, and 
a few old coquets. Far from producing the effect so much 
wished for, these various preparations are fit for nothing 
but to precipitate the appearance of age ; they deepen the 
wrinkles, ruin the skin, arrest the perspiration, bring on 
tetter of different sorts, pimples and erysipelas. It is true, 
that some of them succeed in dispersing spots, and some 
forms of cutaneous eruptions, but then, they are generally 
followed by metastasis and repercussion, that are mostly 
very dangerous. Salivation, tremors, palsy, convulsions, 
lead colic, ophthalmias, inflammation of the stomach, of the 
liver, and the lungs, have been the miserable consequences 
produced by the application of various metalic prepara- 
tions to the skin. It is a duty, however, to observe, that 
the rouge, called "vegetable rouge," prepared from the 
carthamus, as well as that extracted from red sanders 
wood infused in alcohol, from cochineal, from the root of 
the alkanet, Brazil wood, and other vegteable substances, 
is attended with little danger, provided it be seldom em- 
ployed and in moderation. According to Prof. Chaussier, 
the steatite may be made use of, without much inconveni- 






GENERAL HYGIENE FOR WOMEN APPLICATA. 77 

ence, for the purpose of whitening and polishing the skin, 
and even as a preventaive against certain contagious dis- 
orders. 

Where fresh water, the best and most efficacious of cos- 
metics, will not suffice to cleanse the skin, or restore its 
brilliancy and suppleness, lost by the abuse of pleasures, 
prolonged vigils, the use of paint, the action of me air, 
and the solar rays, etc., the ladies may successfully employ 
a balsamic lotion, prepared by mixing ten drops of balsam 
of Mecca, a drachm of sugar, the yolk of an egg, and 
six ounces of distilled rose water, or fleurs defeve. She 
might, likewise, make use of the cucumber ointment, 
beurre de cacao ointment, or sweet almond ointment, tak- 
ing care to get them fresh, and without any combination 
with the metalic salts, that certain perfumers are in the 
habit of mixing with them. 

Cucumber ointment, or the salve made from the same 
vegetable, and colored with alkanet root, and perfumed 
with a drop of the essence of roses, is the only article 
that can be safely employed, either for protecting the lips 
from the irritating action of cold weather or for giving 
them the vermilion tint, which disease had deprived them 
of. A woman ought always to refuse to employ the dif- 
ferent sorts of vinegars for the same end. She will do 
well, also, not to use, without great circumspection, most ■ 
of the so called treasures of the mouth, into the composi- 
sition of which various acids are known to enter, and 
the presence of which render them quite injurious to the 
teeth ; * the tincture of guaiacum, the vinous tincture of 
bark, and the spirit of cochlearia, are the best dentifrices 
for the preservation of the mouth. A mixture of water 
and alcohol, with a few grains of sal ammoniac may also 
be very beneficially employed, and the powder of Peruvi- 
an bark, or charcoal, or burnt bread, incorporated with 
honey, compose an opiate which is very suitable for whiten- 
ing the teeth, removing the tartar that encrusts them, and 
thereby for preserving them from the attacks of caries. *f* 



*Dr. Regn&rd has proved that the action of acids on the teeth is the 
<nost common, and almost sole cause of decay. 
tM. Faveau, a skilful dentist of Paris, makes a most successful use of 
5 



78 GENERAL HYGIENE FOR WOMEN APPLICATA. 

This opiate ought to be used at least once a week, and <t 
is right to rinse the mouth after each meal, with cool wine 
and water, and to do the same thing each morning, with 
water containing a portion of some one of the liquid den- 
tifrices we have mentioned, or merely a little eau de co- 
logne ; no one should ever clean the teeth except with a 
soft bi*ush ; nor should they take cold drinks immediately 
after taking their food very hot. 

The cosmetics prepared for the hands, and all the cuta- 
neous surfaces, with a view to their neatness, consist of 
pastes and flour of sweet and bitter almonds, of fecula, 
and of aromatic soaps. We think it a duty, however, to 
say that the Windsor and Palmyra soaps, which are in 
most general use, are but ill-suited to preserve the softness 
and suppleness of the skin, because they always contain 
an excess of alkali, which dries, and at last cracks it. 
None of these objections are chargeable against the liquid 
soap called Oleine, prepared by M. Guerlain, Perfumer, 
at Paris. 

The caustic substances that enter into the composition 
of depilatories, should be sufficient motive for rejecting 
their use; not only may they give rise to serious symp- 
toms, but there is the further objection, that they do not 
fulfil the end proposed ; for the hair which they cause to 
fall, soon grows again. All those metalic substances, also, 
that are used for dying the hair, should be banished from 
a lady's toilet, as being very dangerous articles. They 
mostly consist of nitrate of silver, or a mixture of sulphu- 
ret of lead or quick-lime, to be diluted with water at the 
time of using it. We add, as to what relates to the care 
of the hair, that she ought to confine herself to the use of 
the comb ; to wash it from time to time with water, and to 
detach the dandruff occasionally with a brush ; and, lastly, 
she should tress it with a grace, and perfume it occasion- 
ally with some perfumed oil. 

We shall close, by reminding the ladies that too fre- 
quent dressing of the hair, with hot curling tongs, dries, 
and makes it early turn gray ; that metallic combs cut it, 

a ciment obliferique, for the purpose of arresting decay, and curing pains 
of the teeth; it is composed of anhydrous sulphate of alumine and an' 
alcoholic and etherial extract of the pistachio, lentiscus 






GENERAL HYGIENE FOR WOMEN INGESTA. 79 

and that the various pomatums recommended for improv- 
ing the growth of the hair, have no other effect than to 
cover it with a coat of grease, consisting, for the most 
part, of colored tallow, perfumed and occasionally mixed 
with oil or beef's marrow. Let us observe, moreover, that 
cleanliness and native elegance, the graces of the body as 
well as those of the mind, and, in fine, good temper and 
modesty, are the most powerful of cosmetics. 

3. Ingesta — food, drinks, etc. — Although it be diffi- 
cult, not to say impossible, to trace out the rules of ali- 
mentary regimen applicable to all women alike, we may 
state that their food ought to be proportioned to their con- 
sritution and to the exercise they undergo, as more or less 
fatiguing. Their taste naturally inclines them to prefer 
such dishes and beverages as are of easy digestion, and 
most of them, likewise, are very fond of fruits — prepara- 
tions of milk and all the lighter kinds of food, or such as 
are taken from the vegetable kingdom. Yet some there 
are, who, giving way to a false appetite, have the habit of 
overloading the stomach with food ; but it generally hap- 
pens that their exaggerated digestive power leads them to 
a state 6f corpulency and excess of embonpoint, which 
by depriving the body of its suppleness, its activity, and 
all its natural proportions, are as unfavorable to its beauty 
and its health, as leanness itself. There are also many 
women to be met with who are extremely addicted to the 
use of high-seasoned food and to spiritous and aromatic 
drinks ; but most of those who thus transgress the laws 
of hygiene are found to be barren, lean, of a bilious 
temperament, and subject to attacks of uterine hemor- 
rhage, menstrual disorders, cutaneous eruptions, and also 
to inflammation of the womb and bowels. 

Women who desire to retain, during the longest possi- 
ble period, the advantages of youth, of beauty, and above 
all, of health, should wholly abstain from liquors, stimu- 
lating, acrid, and spicy dishes, from fat meats, pastry, and 
in one word, from all kinds, of food artfully prepared to 
exaggerate the li?nits of the appetite and create factitious 
wants. Light kinds of food, derived from the vegetable 
kingdom, meats of easy digestion, boiled or roast meats, 



80 GENERAL- HYGIENE FOR WOMEN EXCRETA. 

fish, birds and game plainly dressed, milk in its various 
preparations, fruits, herbaceous vegetables, and lastly, 
water, pure, and under proper circumstances with a little 
red wine — such should be the constituents of diet for a 
Woman from puberty to the " change of life." We, 
moreover, give it as our opinion that the frequent use of 
tea and coffee, is in general hurtful to women, and espe- 
cially to those who shine less by their intellectual qualifi- 
cations than by their beauty and all the perfections of 
their merely physical nature. 

4. Excreta — excretion of the menses, the fjeces, 
the urine, the sweat, etc. — Our bodies so often waste 
and repair the materials of which they are constituted 
that we may compare one of them to the vessel of The- 
seus, which was so often repaired, that at length not one 
piece of its original timbers was left. As the condition 
of health chiefly depends upon the perfect harmony of 
this double action, it is easy to understand why it is of 
importance to promote, and sometimes to moderate the 
different secretions of the animal machine. Women 
should not only follow out the hygienic rules we have 
traced out for them in reference to their menstruation, but 
they ought to pay a special attention to the excrementitial 
evacuations, to see that they are effected in due proportions 
at the periods, and by the routes assigned for them by nature. 
Their attention is chiefly required as to the urinary and 
faecal evacuations ; that is to say, they ought to yield to 
the first solicitations of the one, and facilitate the expul- 
sion of the other, by mild food, cooling drinks, and occa- 
sionally by means of emollient enemata, and by supposito- 
ries, where there happens to. arise a state of obstinate cos- 
tiveness. 

It is needful, also, to watch with the same scruples, the 
state of the perspiration, remembering that on the one hand, 
too much perspiration brings on general debility, and ren- 
ders the skin susceptible to the vicissitudes of the weath- 
er, whilst on the other hand, a sudden suppression of the 
sweat occasions an infinity of disorders of a nature more 
or less severe. To keep up a gentle perspiration of the 
whole skin ; to keep the person perfectly clean ; to dress 



GENERAL HYGIENE FOR WOMEN GESTA. 81 

moderately and suitably as to the season ; to abstain from 
all immoderate exercise, and, lastly, to avoid sudden 
transitions from heat to cold ; such are the means by 
which they may keep up a constant, regular exercise of 
the functions of the ecomomy. 

GESTA EXERCISE, LATE HOURS, SLEEP, REST, ETC. 

To keep herself in a state of health as perfect as may 
comport with the mobility of the organization, the female 
should addict herself to a moderate amount of exercise, 
which should end, however, as soon as it becomes fa- 
tiguing. All the world knows that the celebrated Tron- 
chin, when he was called to the court of Louis XVI. and 
. consulted by nervous ladies as to their disorders, never 
recommended anything but exercise, sustained and varied 
by all sorts of dissipation. He pushed the rigor of his 
orders so far as to prescribe for them the very duties their 
valets had been accustomed to perform for them ; and the 
coquettes and high dames of the court were seen polish- 
ing the inlaid floors, which they had before scarce deigned 
to press with their feet. 

We ought, also, in this relation, to bring to mind the 
inestimable value of rural pursuits. The aroma of plants 
and flowers exhaled at sunrise, the oxygen which is set free 
in torrents under the influence of light, the ravishing aspect 
of nature, the melodious song of the birds, all serve to pro- 
cure the most delicious sensations, and impart to the 
organs an incredible amount of strength and health. 

Among the exercises to be regarded as most suitable for 
females, are those connected with house-keeping, walking, 
as an amusement, or as a prescription, riding on horse- 
back, jumping, and above all, dancing, provided it be not 
continued to a late hour of the night, nor indulged in 
immediately after a repast or during the catamenial flow. 
The waltz, which has on very good grounds, met with 
many opponents, conjoins with the disadvantage of fatigu- 
ing too much, the greater one of propelling the blood too 
strongly towards the principal internal organs, and espe- 
cially the heart, lungs and brain. 

Speaking, reading aloud, and, above all, singing, con- 
tribute more powerfully than might be supposed to the 

E 



82 GENERAL HYGIENE FOR WOMEN GESTA. 

conservation of the health, and the prevention of many 
affections of the lung, and stomach. Moderate ex"ercise, 
moreover, increases the appetite, facilitates the digestion 
of the food, energizes the circulation of the fluids, pro- 
motes the secretions and the excretions, and augments the 
power and activity of all the systems of organs. When 
carried to excess, it is far from producing such salutary 
effects ; for it then exhausts the organs, reduces the 
strength, and renders all the functions languid. In fine, 
leisure, indolence, luxurious habits, the soft and sedentary 
tone of life which are the very vices of education among 
the wealthy, leave the body in a state either of debility or 
of lymphatic embonpoint, and frequently constitute the 
chief causes of a thousand nervous affections, and that 
excessive sensibility which renders even the gentlest 
impressions absolutely painful. 

It is impossible to repeat too often, that exercise is the 
surest antidote to the continued state of suffering complain- 
ed of by many ladies in high life. Let a languishing 
coquette, pale and vapory, keep company with strong, 
healthy village girls, and participate in their labors as 
well as their amusements, for a while ; she will soon find in 
herself a most admirable metamorphosis ! Her digestion, 
which was disordered, will be gradually restored ; her 
strength will return in company with the freshness and 
bloom of her complexion ; indeed, her whole nervous sys- 
tem will be corroborated, and the desperate languor and 
mobility which constituted a continued state of suffering, 
will soon give place to a stable and brilliant condition of 
health. 

Rest, which is as needful as exercise, should be enjoyed 
in proper proportion. Late hours are always prejudicial 
to the health of the sex, because they cannot repair in the 
morning the losses of sleep at night, nor with impunity 
invert the invariable order of nature. With those among 
them, who, as they say, turn night into day and day into 
night, all the organs suffer, the functions are deranged, 
the nutrition is very imperfect, the physical constitution 
loses its energy entirely, and the appearance and bloom 
of youth soon depart and give place to wrinkles and old age. 

Although sleep is a means of restoration, with which 



GENERAL HYGIENE FOR WOMEN PERCEPTA. 83 

nature endows us, it ought not to exceed certain bounds ; 
that is, it ought not to be prolonged beyond from seven 
to nine hours. Sleep solicited by too soft a* bed, plunges 
the nervous system into a sort of stupor, induces debility 
rather than procures strength, and brings about a fulness 
of the vessels, followed by torpor of the circulation, and 
not rarely by hemorrhage. Upon the whole, the female 
ought to retire early to bed, be up betimes in the morning, 
and pass her waking hours in occupations that may 
exercise without fatiguing the organs. 

PERCEPTA PASSIONS, INTELLECTUAL LABORS, ETC. 

Helvetius says, " that the passions are the celestial fire 
that vivifies the moral world ; it is to them that the arts 
and sciences owe their discoveries, and man the elevation 
of his position. " It is true, however^ that while some of 
them are useful to him, the greater portion of them agitate 
the current of his existence, fill it with storms, and curtail 
its duration. Their influence upon his health is questioned 
by none, whether they act slowly or whether they burst 
forth with impetuous violence : in the former, they are 
like a concealed poison that destroys ; in the latter, like 
a devouring flame. Notwithstanding that each one of the 
passions possesses a character peculiar to itself, and disclo- 
ses itself by characteristic signs, they all have this in com- 
mon — that they pervert the habitual order of the functions. 
The concentrated passions, such as jealousy, hate, fear, 
envy, grief, and its varied forms, direct their action prin- 
cipally upon the diaphragm, the stomach, liver and womb, 
all of whose functions they are capable of disturbing. 

The intense passions, as .well as emotions, whether 
agreeable or painful, felt in excess, impart shocks so 
violent that the most alarming symptoms and even death 
itself may be brought on by them. Tissot knew a 
female at Lausanne, who fell into convulsions whenever 
the name. of her rival was mentioned in her presence. In 
the annals of France, we see that a princess of Condi died 
of jealousy on hearing that her busband had attached 
himself to a lady of honor, to Catherine de Medicis. Vale- 
rius Maximus speaks of an Athenian lady who lost her 
speech in an excess of rage \ andBuchan reports the case 



84 GENERAL HYGIENE FOR WOMEN — PERCEPTA. 

of a woman who died suddenly with cerebral hemorrhage 
produced by a similar cause. Lastly, Prof. Rostan saw 
a lady perish in the course of two days, with an attack of 
peri-pneumonia, with which she was seized upon reading 
a letter that announced the death of her son. Let us 
further add, that a sordid interest led to the sudden death 
of Leibnitz's niece. That celebrated philosopher had 
scarcely yielded his last sigh when his avaricious heiress 
caused his trunks to be opened, and upon seeing the piles 
of gold he had bequeathed to her was so filled with delic- 
ious joy that she expired before she could count them. 
We also observe, that Cromwell's daughter, after the 
execution of Charles I., was so indignant at having for her 
father the assassin of her King that she died of despair. 
Although the lively emotions and impetuous movements of 
the soul do not always produce such fatal effects, they 
always act in an injurious manner upon the economy, and 
principally among women whose sensibility and imagina- 
tion are commonly of an exalted cast. 

We conclude with remarking, that literary labor, or 
abstract studies, protracted meditations, which in a man- 
ner, concentrate all the vital forces upon the organ of 
thought, are also, very prejudicial to females. Conflicts 
of the mind are especially hurtful to them, at the period 
when nature calls upon them to fulfiill the important func- 
tions of their sex ; and at an age when they ought to shine 
rather by the advantages and graces of youth, the art of 
pleasing and the charms of their conversation, than by a 
scientific or literary reputation, which men, even, never 
purchase but at the expense of both their health and their 
happiness. 



PART IV. 



DISEASES OF THE INTERNAL GENITAL ORGANS. DERANGED 

MENSTRUATION, WITH OTHER FUNCTIONAL DISORDERS, 
AND ORGANIC DISEASES. 



CHAPTER I. 

SYMPATHIES OF THE UTERUS, WITH PRELIMINARY OBSERVA- 
TIONS UPON DISEASES OF THE INTERNAL ORGANS ; THEIR 

GENERAL CAUSES, DIAGNOSIS, AND TREATMENT. 

Before proceeding to the consideration of special dis- 
eases of these organs, a few observations upon the sympa- 
thies of the womb, and general remarks on the causes, 

DIAGNOSIS, AND TREATMENT OF DISEASES OF ' THE FEMALE 

genital system, may not be out of place. 

The sympathies of the womb, were formerly very much 
misunderstood ; its influences were supposed to be almost 
innumerable, and powerful beyond comprehension. It has 
been handed down, from the most ancient times, that the 
uterus governs all other functions of the economy, with a 
potent sway, and no less powerful than capricious; that 
it not only forms and governs the moral character of the 
female, but that it regulates the physical organization in 
every portion of her body, and creates, exalts, and modi- 
fies all the diseases with which she is afflicted ; hence the 
declaration of Van Helmont : Propter uterum solum, mu- 
Her id est quod est ;* and of Hippocrates : Propter solum 
uterum, mulier tota morbus est."\ 

* By reason of the uterus, alone, woman is what she is. 
t On account, alone, of the uterus, woman is all disease. 



86 SYMPATHIES OF THE UTERUS. 

By some, the uterus was declared to possess a separate 
life ; that it had its own peculiar mode of existence, and 
that it was wholly independent of the laws which govern 
the system in general. Aretseus speaks of it as " an ani- 
mal confined within another animal ; that it travelled with- 
out restraint from any portion of the body to another ; that 
it would take possession of any sense ; or occupy any vis- 
cera, whether situated at the right or left side of the body ; 
but that its movements were rather towards the inferior 
portions of it. That it was like a wandering being ; that 
it relished agreeable odors, and would move itself towards 
the place from which they appeared to emanate ; but would 
remove itself, in sadness, from places which had disagree- 
able smells, 5 ' etc. Plato remarks, that " the womb is a 
wild beast, that obeys no reason, but which, when its de- 
sires are unsated, wanders about within the body and ex- 
cites all sort of irregular motions." 

Thus, it is evident that the ancients were not only igno- 
rant of the true sympathies of the uterus, but, also, of its 
anatomy, and even of its situation and relation to other 
organs of the body. Quite as far from the real truth, too, 
regard we the opinions of some modern authors ; one of 
whom, declares that the uterus is of so little consequence 
to the animal economy, that it might be spared from the 
body, without the system suffering from its removal ; and 
that it has but little influence or control over the functions 
of the body.* 

There is nothing more positively known, than that there 
exists a- certain sympathetic power, the influence of which 
may be received by one or several organs of the body, 
from some remote organ, mechanically disconnected. 
Such sympathy seems to depend upon a peculiarity of or- 
ganization, by which the parts so constituted, are induced 
to vibrate in unison, and irradiate the impressions they, 
receive upon each other. Whether this is directed by 
nervous anastomosis, or by the intervention of the brain, 
or in some other manner, is as impenetrable to us as is the 
veil which conceals the real nature of the nervous power. 

*Mr. Fogo, a few years since, in a paper entitled, "On the degree of 
importance which should be attached to the functions of the uterus, in 
regard to health." 






SYMPATHIES OF THE UTERUS. 87 

We shall restrict ourselves in this place, to a brief state* 
merit of the most prominent sympathies of the uterus ; 
they are so evident, that it would be absurd in the highest 
degree, to call them in question. A knowledge of this in- 
fluence is of very great importance ; and, in fact, some- 
times, this sympathetic phenomena is the only clew to ute- 
rine disease. Distinguished physicians have been fre- 
quently consulted for diseases referred to the breasts, sto- 
mach, bowels, and heart ; also, for neuralgias, loss of voice, 
etc., (see- chapter on hysteria) which were, in reality, but 
the sympathetic reaction of a disease of the womb, that 
might have been made certain on an examination by the 
touch. Under such circumstances, the symptoms only are 
combatted, instead of the disease which gives rise to them. 

1. The sympathy of the uterus with the breasts : we have 
before adverted to this subject, (see page 29) and shall 
now state, in addition, other facts. It is universally known 
that the sucking and tittillation of the nipple by the infant, 
frequently give rise to sensations referable to the genitalia. 
The breasts of pregnant women, when the foetus dies, be- 
come flaccid — also, during uterine hemorrhage ; and the 
suppression of the menses, or the lochia, and the disten- 
sion of the womb by polypus and moles, frequently pro- 
duces a secretion of milk, and, sometimes, a milk fever. 
Women who are suckling, and have an abundant secre- 
tion of milk, do not generally menstruate, have but little 
lochia, and are rarely subject to leucorrhea; whereas, 
those who but half fulfil the obligations of a mother, lose 
their milk, are liable to copious menstrual discharges, 
abundant lochia, and leucorrhea. 

2. The sympathy with the stomach is evident, from the 
strange and capricious appetite, nausea, vomiting, etc., 
which arise during pregnancy and irregularity of the 
menses. 

3. The sympathy with the brain is sufficiently mani- 
fest : pregnant women, sometimes lose their memory, or, 
on the other hand, have it greatly strengthened ; their 
imagination is more lively, or they become less intelligent. 
They are sometimes prompted to strange acts, become par- 
tially insane, etc. Also, it frequently happens that, vio- 
lent fits of passion, emotions of the mind, jealousy, etc., 



88 PRELIMINARY OBSERVATIONS. 

arrest the flow of the menses and lochia, and suspend the 
secretion of milk ; whereas, the whites are increased. 

4. The sympathy of the uterus with the respiratory and 
vocal organs is proved by the palpitations, faintings, spit- 
ting of blood, loss of voice, and other phenomena that 
occur during the existence of uterine disorders, and in 
pregnancy. 

The sympathies that exist between the uterus and 
numerous other organs are manifest, from the many 
changes that occur at puberty, and at the change of life ; 
the sensations excited by the kiss of a lover ; the tooth- 
ache, ringing in the ears, indigestion, colic, and other 
symptoms supervening during pregnancy ; the cessation 
of uterine catarrh by its establishment in some other part ; 
vicarious menstruation, and the suppression of the menses 
upon the application of cold to the hands and feet ; and a 
great variety of other phenomena, which — remarks L'ls- 
ere — prove the accuracy of these two aphorisms of Van 
Helmont — On account of the uterus, woman is what she 
is. . ..all women are doubly diseased.* 

He also remarks : Any researches made in this direc- 
tion (to explain the causes of the great influence of the 
womb upon the entire economy) would certainly tend only 
to prove still more conclusively that man may ever seek 
in vain to lift up the veil that shrouds the impenetrable 
secrets of nature. 



The diseases of the uterine system may be divided 
into functional and organic 

1. The functional disorders consist of those variations 
from the natural secretion of the menses, which are com- 
monly known as Amenorrhea, or suppression of the menses ; 
Dysmenorrhea, or difficult and painful menstruation ; and 
Menorrhagia, or excessive menstruation. Menstruation 
may be scanty or altogether absent, whether its place 
be supplied by a vicarious discharge, (leucorrhea) or not, 
or it may be in excess.* The character of the menstru- 
ous fluid varies at different times — it ought to be the color 



* Propter solum uterum, muiier id est quod est femina omnem bia 

patitur morbem- 



DISEASES OF THE UTERINE SYSTEM. 89 

of venous blood; but it is sometimes lighter, merely tinged 
with red, and sometimes darker. It may possess greater 
or less consistence than natural. In the healthy state, 
it does not coagulate, but in some kinds of derangements, 
clots are frequently discharged. In health, it has but a 
faint, sickly odor, which is occasionally superseded by a 
strong, disagreeable smell. 

An internal examination, rarely reveals anything un- 
usual in these conditions of the uterus : its density may 
vary a little, and the heat may be increased ; and in some 
derangements, the mouth and neck of the uterus are ob- 
served to be more open and flabby than usual, while in 
others they are somewhat narrowed, by contraction of 
the muscular fibres. But these disorders, when uncom- 
plicated, may continue for years, without having any ten- 
dency to run into organic disease of the womb. 

2. The organic diseases of the uterus and its appenda- 
ges, are often the result of inflammation, either of the 
mucous membrane, or of the muscular and vascular tis- 
sues ; — giving rise to induration, softening, ulceration and 
abscess. The secreting surface of the uterus may give 
rise to purulent discharges, or, its cavity may be distended 
with air, fluid, or degenerated masses, called moles and 
hydatids. 

A change of nutrition, also> takes place, forming fibrous 
tumors ; they are found of different degrees of consistence, 
flabby, soft and dense, and occasionally containing portions 
of calcareous matter. 

The womb is subject, also, to malignant diseases, in 
the form of fungous growth, ulcerations, and of morbid 
depositions. The fungous, denominated cauliflower excres- 
cence, is nothing more than a mass of enlarged and dis- 
eased vessels, with their cellular substance. Malignant 
ulcerations, or corroding idcer first attacks the neck of the 
uterus, and then spreads with varying rapidity to the body 
of that organ, and frequently to the vagina. Cancerous 
deposition may take place in the neck of the uterus, in 
its body, or in both places at once. It may, also, take 
place in the cellular tissue which connects the uterus to 
neighboring parts. 

The uterus is, also, subject to various accidents, such 

E* 



90 PRELIMINARY OBSERVATIONS. 

as rupture, displacement, etc.; the first is generally the 
consequence of violent labor pains. Displacements of the 
uterus are of different kinds, and are consequent upon a re- 
laxation of the usual supports of that organ. We may have 
inversion, retroversion, anteversion, prolapsus, etc. 

The Fallopian tubes and ovaria undergo morbid changes 
similar to those which take place in the uterus ; the most 
common of these are : obliteration of their canals ; disten- 
sion by serous effusion, tubepcula or encephaloid matter; 
adhesion, and cancerous deposition. 

Some additional light may, perhaps, be thrown upon 
these diseased conditions, and the period of their occur- 
rence, if we briefly consider the anatomical changes which 
the uterus and its appendages undergo at the great epochs 
of female life,' and the predisposition thence arising to 
certain disorders. 

Before menstruation has commenced, the uterus is of a 
very dense structure, with vessels and nerves of a size 
only sufficient for its nutrition. The ovaries are small, 
pale, and undeveloped. Up to this period, diseases of the 
internal organs are extremely rare. 

After menstruation, we shall find that the womb has 
undergone a change. It has increased in size and is of a 
softer texture ; the vessels are enlarged and carry more 
blood. The nerves, too, if not much enlarged, are more 
excitable. The mucous membrane is of a florid, red color, 
and a train of pathological phenomena commences. First, 
we may have various functional disturbances and local 
congestions with a discharge of blood. Then, neuralgia of 
the uterus, hysteria, leucorrhea, or inflammation, with its 
consequences, although the latter is more frequent at a 
later period. The establishment of menstruation exercises 
an important sympathetic influence over other and distant 
organs. The brain and nervous system, the stomach and 
intestinal canal, the glandular system, etc., are exposed to- 
new, energetic, and morbid influences. 

After conception and dicing gestation, a further change 
of structure takes place. The mucous membrane lining 
the uterine cavity, becomes more vascular, and is quick- 
ened into increased action, for the purposes of pregnancy. 






DISEASES OF THE INTERNAL ORGANS. 91 

The walls of the uterus lose their density, and are much 
enlarged, for the accommodation of the blood vessels, 
which are very much increased in size, carrying many 
times the ordinary quantity of blood. The lymphatics 
and nerves are, also, proportionally developed. The ova- 
ria are more vascular than usual, and increased in volume. 
The uterine disorders which occur during gestation, are 
in accordance with the anatomical condition of the organ ; 
there may be irregular distribution of blood, as congestion, 
inflammation, hemorrhage, etc., neuralgic pains and spas- 
modic difficulties. The canals of the Fallopian tubes are 
subject to obliteration, and the ovaria to distension, by the 
formation from inflammation of serous, and purulent 
matter. 

After a safe delivery, these peculiarities lose their promi- 
nence, but the uterus is not left in the same state as be- 
fore impregnation — and every succeeding pregnancy de- 
velops still more these changes. Now the diseases which 
prevail during the child-bearing period, answer exactly to 
these changes ; from the increased amount of blood in 
circulation, and exaltation of the nervous influence, we 
have frequent hermorrhage, and nervous difficulties, and in- 
flammation of the substance and lining membrane is more 
frequent than previously. We seldom see ulceration to 
any great extent, or lesions of nutrition, till towards the 
latter part of this period. 

In elderly women, after the child-bearing period, the 
vessels and nerves of the uterus are found diminished in 
size ; the lining membrane is thicker than at an earlier 
age, and pale; but the substance has acquired, through- 
out, nearly its primitive density, and considerably more at 
the neckof the uterus, presenting, in fact, a cartilaginous 
appearance. The canal leading to the uterus is nearly, 
and in many cases quite obliterated, the vagina and uterine 
ligaments are greatly relaxed, and the ovaries very much 
shrivelled. In accordance with this change, active inflam- 
mation and hermorrhage are much more rare, but destruc- 
tive and organic diseases are more frequent; asflbrous and 
fleshy tumors, morbid fungous growths, and cancerous de- 
position. From the obliteration of the canal of the neck, 
an accumulation of mucus in the uterine cavity, some- 



92 PRELIMINARY OBSERVATIONS. 

times leads to rupture of that organ ; and the relaxation of 
the supports of the uterus readily admits of prolapse. The 
ovaria, also, at this period are subject to lesions of nutri- 
tion, giving rise to various solid and fluid deposits, and ma- 
lignant fungoid diseases, similar to those of the uterus. 

As the diseases of the vagina are often closely connect- 
ed with those of the uterus and its appendages, we shall 
include them all under the same head. 

Causes. — All circumstances of evil influence, or which 
deviate from the design of nature, may be regarded as 
causes of the various genital affections. They may, in 
reference to particular diseases, generally, be divided into 
the predisposing and exciting; which distinction we 
shall make, when practicable in speaking of individual 
disorders. Among these circumstances, as most promi- 
nent, we may mention abusus coitus, masturbation, conti- 
nence, celibacy, sterility, laborious labors, abortions, and 
drying up the milk. Those females who reside in large 
cities and live in a state of opulence, are afflicted with 
a greater number and variety of diseases, than those of 
the country and less exalted rank ; this is doubtless ow- 
ing to the latter being less under the influence of those 
perturbing causes, to which those who reside in cities, and 
the opulent, are perpetually subject. 

On account of the sympathies that exist between the 
genitalia, and other parts of the economy, as we have seen, 
should be reckoned among the most common causes of the 
diseases of females in large towns, and among the opulent 
classes — the impurity of the atmosphere ; disregard of the 
laws of hygiene ; cold and astringent cosmetic lotions for 
the vulva, during, or soon after the menses ; the use of 
emmenagogues protracted vigils ; the use of foot-warmers, 
exciting dishes and the immoderate use of tea, coffee, wines 
and ices ; excitements and commotions ; illicit enjoy- 
ments ; viewing theatrical representations and reading 
works of fiction ; indolence ; jealousy, disappointed love, 
and loss of fortune ; and, in short, all the violent emotions 
and passions of the mind. All of these, and other similar 
causes act more powerfully among city women, because 
they are, in general, endowed with the liveliest imagina- 






DISEASES OF THE INTERNAL ORGANS. 93 

tion, and extremely nervous and impressionable — espe- 
cially those of the elevated class. 

In country women and among the less opulent classes, 
these affections often depend upon different causes : such 
as a marshy residence, a damp and badly-lighted dwelling ; 
violent exertion, blows and falls ; atmospheric vicissitudes, 
sitting on the cold ground, and the immersion of the hands 
or feet in cold water ; the continued use of too unnutricious 
food, and alcoholic drinks; the use of emmenagogues; 
meddlesome midwifery ; sedentary labor in cellars and low 
damp work-shops ; finally, rage, libertinism, drunkenness, 
filthiness, etc. 

Diagnosis. — The diagnosis of uteiine disease is of 
great importance, and often requires great care and skill. 
Tke information for this purpose is derived from three 
sources: 1. From the symptoms. 2. From a manual or 
tactile examination, as touching per vaginam, per rectum, 
etc. 3. From a visual examination by the speculum. All 
of these means will be detailed at length 2 for the purpose 
of distinguishing individual diseases, when we come to 
speak of them. 

When there is any doubt in regard to the nature or lo- 
cation of a disease of these organs, the most delicate female 
should not object to such examination as may lead to a 
knowledge of the cure of a disorder, which otherwise 
might prove speedily fatal. It is needless to say, that the 
greatest gentleness should be, and is used by every 
gentleman, and the examination repeated as seldom as 
possible. 

Treatment. — As we shall dwell at length upon the 
treatment, when speaking of individual diseases, we need 
barely advert to the subject in this place. There are some 
medicines that are regarded as emmenagogues : such as the 
ergot, iron, strychnine, aloes, electro-magnetism, cantha ri- 
des, etc., which seem to act directly upon the uterine 
system. 

Preparations of iodine have latterly been successfully 
used, particularly the iodide of potash. Calomel and opium 
exert a remarkable power over uterine inflammation ; and 
5* 



94 TARDY APPEARANCE OF THE MENSES. 

cupping the loins, or the application of leeches to the 
vulva, anus, or over the pubis, are highly useful. Of 
late years, blood has been extracted directly from the neck 
of the uterus, by means of the speculum, with leeches and 
scarification. By the same means caustics may be ap- 
plied to the part affected without injuring the vagina : as 
nitrate of silver and mercury, butter of antimony, efc, in 
ulcerations and excoriations. 

In diseases of the vagina and neck of the uterus, injec- 
tions of various substances may be thrown up by a sy- 
ringe — as astringent decoctions and infusions, solutions of 
sulphate of zinc and copper, nitrate of silver, etc. Emol- 
lient and anodyne injections, as well as those of simply 
warm and cold water, are, also, very useful. 

An appropriate system of hygiene, is one -of the most 
important means of cure, and should never be neglected. 
A proper diet, the judicious employment of the external 
application of cold and tepid water, counter irritation, the 
use of anodyne plasters, etc., etc., are all of great import- 
ance, and will be pointed out when their several virtues 
are required in different diseases. 



SECTION I. 

FUNCTIONAL DISORDERS. 



CHAPTER II. 

SUPPRESSION OF MENSTRUATION AT PUBERTY, OR TARDY AP- 
PEARANCE OF THE MENSES FOUR DIVISIONS CAUSES- 
SYMPTOMS AND TREATMENT. 

It has been stated, that in this climate the average 
period of puberty in the female, is from the fourteenth to 
the fifteenth year — which is indicated by the menstrul dis- 
charge. If, however, the usual period arrives and we 
have, or have not, the signs as enumerated in Chapter I. 



TARDY APPEARANCE OF THE MENSES. 95 

and II. of Part III., and the mensesdo not occur, or if they 
have been established, and disappeared again from other 
causes than those of pregnancy, suckling and old age, the 
individual is said to labor under suppression of the men- 
ses. There are two forms of suppression, each of which 
is important, as being intimately connected with its proper 
understanding and treatment. 

The first form is that, when from age or personal de- 
velopment, it is judged that the proper period of puberty 
has arrived — and it does not appear at all — known as 
tardy appearance of the menses. This form originates 
mostly fioni constitutional causes, and is the subject of 
this chapter. 

Tb'3 second form is that, in which it has appeared, but 
is infer • upted after having been established ; this is the 
proper Amenorrhea or suppression of the menses, of au- 
thors, and will form the subject of the next chapter. 

There are several divisions of the first form, or tardy 
appearance of the* menses, which we shall notice in order. 
The first, is when at the usual age of puberty, there is little 
or no development of the female system. The second, is 
when th.are are indications of development, which is but 
slowly taking place. The third, is when this develop- 
ment Is interrupted by a chronic affection of seme other 
part. The fourth, is when the most perfect development 
of tha female constitution has taken place, yet it does not 
appear. 

1. When there is little or no development of the female 
sytem at the age of puberty. This is easily detected by 
the absence of all the signs which should characterize the 
appearance of womanhood ; the breasts do not enlarge, 
and in fine, none of those changes occur which are enu- 
merated in Chapter I. and II. of Part III. The cause 
may be, imperfect development, or malformation — as ab- 
sence of the ovaria, or uterus. It is evident that in such 
a condition, it would not only be useless, but it would be 
inhuman and cruel to torture a girl's system with stimu- 
lating emmenagogues, which may be in good condition, 
merely because she has attained her fourteenth or fifteenth 
year. We have spoken plainly on this point, at page 68 
and 69, and shown that when it is practicable time, etc., 



96 TARDY APPEARANCE OF THE MENSES. 

is all that is required, to effect the anxiously hoped for 
change. 

In this condition, if the mother or friends of the female 
are rational and informed upon the subject, they will see 
the entire insufficiency of medicine to produce the desired 
end. But, they sometimes act in open defiance of knowl- 
edge, even after possessing it, to the imminent risk of the 
destruction of the poor girl who is the object of their 
solicitude. Dr. Dewees mentions a parallel case to that 
mentioned at page 69, of the sad fate of a " most amiable 
and interesting young creature," for whom he was re- 
quested to prescribe for the expected menses. She was in 
perfect health, and had not a mark of womanhood — though 
she was fifteen years of age — and this was all that could 
be urged by the mother in favor of an attempt to " bring 
down her courses." He relied upon the good sense of the 
parent, freely explaining to her that no medicine was 
needed, and heard nothing more of the girl for six months. 
At the end of this time, he was suddenly summoned again 
to attend her ; he found her alarmingly ill, throwing up 
large quantities of blood, and she died a few days after 
from the excess of this discharge. 

It seems that the mother, with the view of producing the 
menstrual discharge, had procured some medicine of a 
quack, which, upon giving according to his directions, 
produced fever, loss of appetite, and vomiting ; she again 
called upon the " Doctor," and he encouraged her to per- 
severe with the medicine,, saying that the fever, etc., was 
an effort of nature for the end proposed — " she persevered, 
fatally persevered ; for in a few days more she lost her 
lovely and only daughter." The medicine upon exam- 
ination proved to be the oil of savin. 

2. When there are indications of development, which 
is but slowly taking place. This condition is known by 
the partial occurrence of those changes before mentioned, 
that indicate puberty. There is slight enlargement of 
the breasts, some expansion of the body, etc. The gen- 
eral health seems to suffer, especially if the girl have 
passed the fifteenth year ; the face is pallid, and only 
flushed upon occasions of sudden and violent mental ex- 
citement, or physical exercise, which soon oppress and 



TARDY APPEARANCE OF THE MENSES. 97 

exhaust the system. She is assailed by a train of nervous 
svmploms, as they are called, such as palpitation of the 
heart, ringing in the ears, headache, loss of appetite or a 
desire for the most opposite and inconsistent articles of 
diet. This constitutes very nearly what is called the 
.lymphatic temperament: or, that in which the vessels 
are filled with lymph or thin blood. 

This condition is sometimes accompanied by leucorrhea, 
(see that chapter ;) which particularly deserves notice 
when the health appears to suffer. 

A distinguished French writer, in speaking of the 
causes of this affection, remarks : " The general debility 
which is so often the cause and attendant of suppression, 
does not always derive its origin in the primitive constitu- 
tion of the female ; it is often the unfortunate consequence 
of a number of debilitating causes, such as living in a 
low, humid situation, deprived of the light of the sun ; 
aliment of a bad quality ; warm watery drinks ; insuffi- 
cient nourishment; want of exercise, or the fatigue pro- 
duced by labor beyond the. strength ; tedious disease and 
convalescence; leucorrhea; the abuse of sanguine evacu- 
ations ; disappointment and all the depressing passions ; 
and finally, all the causes which impoverish the blood, and 
render it incapable of imparting to the organs the energy 
indispensable for the full exercise of the functions. [^ 
the contrary excess, that is to say, the state of plethora 
(sanguine temperament) produces an analagous effect, it 
is because the blood, too rich in fibrine, forms an obstacle 
to itself, and opposes the periodical exhalation which con- 
stitutes menstruation. " 

These lamentable causes are continually in operation, 
among a great portion of the human family. The health 
of females employed in factories, even in our favored 
country, from their constant deprivation of fresh air, con- 
finement to repulsive and monotonous labor, and general 
restraint of .the natural impulses and desires, must seri- 
ously suffer. We think there can be no doubt, that in the 
vast proportion of individuals thus employed, serious and 
often lasting injury is done to the constitution. 

In the treatment of this form of tardy appearance of 
the menses, our exertions must be directed to the invigor- 



28 TAttDY APPEARANCE OF THE MENSES. 

ation of the system in general, and to the development of 
the uterine system in particular — though to effect the 
former is much assisting the latter. 

The first should be attempted by free exercise in the 
open air, riding on horse-back, when practicable, if not, 
in an open wagon ; walking in proper weather, and when 
the weather will not permit of exercise abroad, skipping 
the rope within doors ; dancing moderately, with care o f 
not over-heating, and cooling too suddenly; all such 
means are useful in giving a healthful impetus to the mind 
and body. By proper attention to dress : clothing enough 
must be worn at all times to ensure a constant state of 
comfort ; wearing flannel next to the skin in cool weather, 
and properly protecting the feet and legs against cold ; 
carefully avoiding damp and wet places, and currents of 
cold air, especially when warm. The diet should be 
moderate and consist of easily digestible substances both of 
the vegetable and animal kind ; using very cautiously 
stimulating drinks, such as wine, spirits, beer, etc. 

All depressing emotions, whether originating in domestic 
unhappiness, or careless indifference to the welfare of her 
children, must be dissipated by the mother and her asso- 
ciates ; under the influence of her presence all unhappi- 
ness should disappear ; home must be a happy place, or 
the health of the female inmates will suffer. In short, all 
those hygienic rules mentioned in Chapter VI., Part III., 
are here applicable, and to them the reader is directed. 

All exercise should be taken before evening, and care 
should be taken not to carry it to the point of fatigue. 
The practice of invalids riding out before breakfast, or 
after tea, should not be permitted, unless great care be 
taken to preserve an even temperature and equable warmth 
of the skin. The invalid should retire to rest upon the 
first approach of drowsiness, never suffering herself to be 
detained by visitors. If it be understood that she is *an 
invalid, no person can be annoyed at her departure. Par- 
ticular attention must be given to ventilation, without 
danger from a current of air; an open door or fire place 
must be principally relied on for this purpose. Tepid 
water and a rough towel should be used for frequent ablu- 
tion — only a part of the body being exposed at a time 



TARDY APPEARANCE OF THE MENSES. 99 

in cold weather, with care to dry thoroughly, and rub into 
a glow before resuming the garments. 

The second, or when our exertions are directed in par- 
ticular to the development of the uterine system, must 
be accomplished by such medicines as have direct or indi- 
rect action on the uterus itself; of the direct kind, the 
tincture of cantharides* seems to be an efficient one, and 
is particularly applicable when leucorrhea attends ; thirty 
drops may be given three times a day and the dose gradu- 
ally increased till this discharge ceases, or is converted into 
the menstruous. 

The various preparations of iron and iodine, in apropri- 
ate doses, are always used with success, particularly when 
there is much general debility of the constitution ; the 
best form of the latter is the tincture with the iodide of pot- 
ash — from ten to thirty drops may be. given from two to 
four times a day. Of the iron, the sub-carbonate, in ten 
grain doses, and the wine of iron in the dose of a drachm, 
are the best forms. 

If the patient should be of a full habit and any degree 
of plethora be present, with symptoms indicating uterine 
effort, a small bleeding will very often afford relief; or, 
perhaps a better mode of abstracting blood, is by leeches 
to the vulva, or cupping the loins. Brisk purging is occa- 
sionally necessary ; and of the indirect remedies for this 
purpose, aloes combined with rhubarb, seems to be the 
most certain ; — it should be given in very small doses, and 
perseveringiy continued. 

Dr. Dewees thinks it preferable — combined as in the 
following F0R3I — to the tincture of cantharides, when leu- 
corrhea does not attend : — 

Gum Aloes, half a drachm. 

Pulv. Rhubarb, . . .one do. 

Oil of Cloves, four drops. 

Venet. Soap, eight grains. 

Syrup Rhubarb, q. s. 

*lt will be understood that no medicine which has a direct action upon 
the uterus, is admissible in this condition, unless there is uterine effort ; 
till there are symptoms of the vessels of the uterus being loaded v>ith 
their secretion, the remedies before noticed, should be continued, to the 
exclusion of specifics. If the cantharides produce strara?uary, difficulty 
of passing the urine, it should be discontinutd until these symptoms 
subside, when it may be agam resumed 



100 TARDY APPEARANCE OF THE MENSES. 

Mix, and make into sixty pills. One of them may be 
given every night, or night and morning, or every other 
night, as they may affect the bowels — the object being 
merely to keep the bowels free. Electro-magnetism, also, 
is a valuable remedy, and deserves a trial. At the time 
medicines are used, the same regard must be paid to air, 
exercise, and diet, as before recommended. 

3. Where this developement is prevented, by a chronic 
affection of some other part. This condition is readily de- 
tected by the presence of any such disease as may be ca- 
pable of interrupting this discharge after it has been well 
established; such as pulmonary consumption ; chronic 
inflammation of the liver, and spleen ; dropsy, etc. The 
existence of either of these diseases will be most certain 
to interrupt the development of the organs essential to the 
formation of the menstrual discharge, however favorably 
this expansion may have commenced. 

In such cases, of course, no treatment will be availing 
but that directed to the removal of the original disease; 
of such diseases we shall not speak in this treatise, as they 
are not peculiar to females. Although the administration 
of medicine is often necessary in such cases, it is only to 
be used as an adjuvant and subordinate remedy to the 
great natural medicines — diet, air, exercise, and cheer- 
fulness. 

In such cases as we have now been discribing, it will 
be seen by the reader, that it would not only be the height 
of folly, but highly injurious to the patient, to administer 
medicines for the purpose of " bringing down the menses" 
as it is termed. The disease, itself, whatever it be, must 
first be subdued by the use of proper remedies, when the 
most gentle efforts may be made to favor nature in her 
attempts to establish, or re-establish this function. 

4. When the most perfect development of the female 
constitution has taken place, yet the menses does not make 
its appearance. This condition is recognised, by the 
young female having all the outward indications of woman- 
hood ; the general character of the constitution is remark- 
able for its robustness ; the appetite and strength are 
good, and although the complexion has not its proper trans- 
parency, nor the eye its proper lustre, the blood-vessels 



TARDY APPEARANCE OF THE MENSES. 101 

seem distended with their contents, and the eruption of 
the menses is all that is wanting to fit her for the duties 
she is destined to fulfil. It seems that in this condition, the 
fibrine of the blood is out of proportion to the serum, thus 
ctogging, as it were, the secreting surface of the uterus. 
It constitutes the sanguine temperament in contradistinc- 
tion to the lymphatic, or that in which the vessels are 
filled with lymph or thin blood, spoken of in the second 
division of this subject. It is sometimes, though less often 
than in the other case, attended by leucorrhea. 

In the treatment, a moderate bleeding is serviceable, 
either from the arm, or by leeches to the vulva, or cup- 
ping the loins. The menses frequently appear a few 
hours after such abstractions of blood ; this may be assist- 
ed by hip and foot baths. In less plethoric cases, and par- 
ticularly where leucorrhea attends, the tincture of can- 
tharides as directed in division second of this subject, will 
rarely fail to produce the discharge if given steadily for 
two or three weeks; the combination of aloes there men- 
tior.ed will, also, be found very useful. In cases where 
there is much irritability of the system, madder, from its 
possessing^ no general stimulating properties, has been 
highly recommended. A strong decoction, made by pour- 
ing a pint of boiling water upon an ounce of this substance, 
in fine powder, with a scruple of bruised cloves, then 
boiling gently fifteen minutes and straining when cool, 
seems to be the best mode of using it ; the dose is a wine- 
glass full every three hours. 

These remedies, if judiciously applied, are generally 
all that is necessary. The diet of the "young girl should 
be of the mildest kind — mostly vegetable, and exercise 
may be moderately taken. 

It will be noticed by the reader, that most of the cases 

of tardy appearance of the menses come under two grand 

divisions — those that are characterized by the lymphatic 

temperament, of a lax fibre, and deficient vitality, and 

those of the sanguine temperament, of an excessive vitality 

and rio;id fibre ; — the treatment varies accordingly — it is 

to be more stimulating in the former, and antiphlogistic in 

the latter. 

6 



102 SUPPRESSION OF THE MENSES ACUTE AND CHRONIC. 

We sometimes have tardy appearance • of the menses 
from malformation. When the uterus, or ovaria, or both, 
are wanting, of course there is no menstruous secretion ; 
but in those rare cases of faulty conformation, where the 
neck of the uterus is impervious, the vagina is wanting, 
or its sides adherent, or its orifice closed by false membrane, 
or an imperforate hymen ; — the secretion sometimes takes 
place and distends the uterus to an alarming extent ; also, 
subjecting the young female to unjust suspicion. In these 
cases, the outward signs of puberty are present, and great 
care must be taken to discover the cause of suppression. 

In the treatment, the obstacles which prevent the 
escape of the menses must be overcome ; if this be too 
long delayed, serious consequences may result. If the 
canal of the neck be impervious, an artificial one must be 
made with a trocar, and a probe passed into the uterus. 
When the canal of the vagina is obliterated, a new one 
may be formed between the rectum and vagina ; when 
this is not possible, the uterus must be punctured through 
the rectum. When adhesions unite the sides of the vagi, 
na, or imperforate hymen prohibit the emission of the 
menses, we should first attempt to rupture them, by separa- 
ting the labia ; if we fail, the knife or trocar, must be 
used, great care being taken to avoid injuring the neigh- 
boring parts. 



CHAPTER III. 






AMENORRHEA OR SUPPRESSION OF THE MENSES, OR ITS 

INTERRUPTION AFTER HAVING BEEN ESTABLISHED ACUTE 

AND CHRONIC CAUSES SYMPTOMS AND TREATMENT. 

We next come to consider that condition wherein the 
flow of the menses, after having been for a longer or 
shorter time established, has been arrested without being 
interrupted by pregnancy, suckling or old age. This may 
happen at any period of menstrual life ; and it may take 
place suddenly, or very gradually, or, in other words, it 
may be acute or chronic. i 



SUPPRESSION OF THE MENSES SYMPTOMS. 103 

1. Acute suppression of the menses may occur from 
various causes, such as sudden exposure to the cold and 
damp air, the immersion of the feet or hands in cold water, 
cold ablutions of the genital organs, sitting upon the 
ground, or a stone bench, etc., during the menstrual flow ; 
the eating and drinking of ices and very cold drinks, 
especially when taken while the body is in a state of per- 
spiration; a violent bleeding; the application of a large 
blister; the employment of purgatives, .of emetics, of 
strong odors; coition during the flow, fever, or any severe 
disease sitting in at that period. Also, a bodily or mental 
shock received just previous to, or during the menstrual 
flow, may produce it ; the vivid emotions of the soul, as 
anger, disappointed love, celibacy, despair, jealousy, im- 
moderate joy, the sudden reception of bad news, a sudden 
fright, extreme fear, or a sudden disappointment ; and 
finally, all circumstances capable of suddenly determining 
the blood in other directions than towards the uterus, may 
give rise to this condition. 

The most common cause, perhaps, is cold applied to the 
feet. The majority of women pay so little regard to this 
period, that they are exposed to frequent derangements 
from this agent, by standing in thin shoes or sitting upon 
cold and damp ground, and going too lightly clothed ; 
some are so reckless of consequences as designedly to stop 
the flow by putting their feet into cold water, when engaged 
for a ball or party. Dr. Frank mentions the case of a 
lady, who, because she expected her lover, put her feet 
several times into cold water during the flow of the men- 
ses, which very soon arrested it ; an inflammation of the 
uterus followed, and she was brought dying into the hos- 
pital at Vienna. So much evil has resulted from such 
and similar impropriety, that the female cannot be too 
careful when the " manner of women" is upon her. 

The symptoms consequent upon sudden suppression, 
vary. Most commonly there is fever, with a sensation of 
heat, weight and pain in the pelvis, uterine colic, disa- 
greeable tension of the loins and upper part of the thighs ; 
enlargement of the breasts and abdomen ; lassitude ; 
nausea, vomiting ; dizziness, headache, ringing in the ears, 
frequent palpitations, burning of urine, etc. Or there may 



104 SUPPRESSION OF THE MENSES TREATMENT. 

be symptoms of local inflammations either of the lungs, 
brain, intestinal canal, or of the uterus itself. 

Occasionally instead of inflammation, there are severe 
neuralgic pains of the womb : or a species of hysteria, 
(see that chapter,) simulating inflammation, and changing 
from one organ to another, as soon as remedies are brought 
to bear upon it. Attacks of apoplexy and paralysis have 
also been known to result from sudden suppression ; as 
also, loss of voice, curious derangements of vision, and 
cutaneous disorders. 

These secondary attacks may be mitigated in severity, 
by the occurrence of vicarious menstruation, discharge of 
blood from some other part, (see the next chapter) by 
which the temporary plethora is relieved, without any re- 
turn of the uterus to a healthy state ; or by uterine 
leucorrhea, which appears to afford relief, and more nat- 
urally, since there is a sort of action of the uterus, which, 
though faulty, seems to be better than having it remain 
perfectly indifferent. On account of the secondary attacks 
to which it gives rise, sudden suppression is a much more 
serious disorder than any other form of menstrual derange- 
ment. 

There can generally be no difficulty in ascertaining the 
fact of suppression ; if, in irregular cases, there should be 
any doubt as to their nature, they should at first be treated 
as simply inflammatory. Attempts are sometimes made 
by unmarried females, with the view of avoiding exposure 
of character, to deceive physicians, in regard to one of the 
causes of menstrual suppression. The well-instructed phy 
sician needs no caution on this point ; and to those who are 
disposed to this course, we would advise a careful attention 
to the chapter on abortion, in Book II. 

Treatment. — The acute form is more easily cured 
than the chronic. First, we should endeavor to recall the 
discharge ; and for this purpose the patient should take a 
warm bath, or put the feet into warm, water, and swallow 
a bowl of hot drink, as whey, thin gruel, etc.* Rest in bed 

* The following potion has been found efficacious : take of distilled 
balm-water, and of orange flower water, of each, two ounces; spirits of 
Mindererus, three drachms; tincture of saffron thirty drops; syrup of 
tolu and orange-peel, of each one ounce — of which a table spoonful ma/j 



SUPPRESSION OF THE MENSES TREATMENT. 105 

should be prescribed, and warmth may be applied to the 
legs and thighs, by means of hot flannels, or bottles filled 
with warm water. Gentle purging will be useful ; but if 
it be induced to any extent the object will be defeated ; 
as copious discharges of any kind, by relieving the consti- 
tution, supersede menstruation, and prevent effort on the 
part of the uterus. The spirits of turpentine combined 
with castor oil — a teaspoonful of each, or more at a dose, 
will often succeed. 

If these means fail to recall the discharge, and there is 
a general state' of plethora, relief will be obtained by loss 
of blood. If adopted early it may prevent the local disor- 
ders to which we have referred ; when they arise they 
must be treated according to the usual method for such 
diseases. The hysterical affection of the different organs 
should be combatted with what are called antispasmodic 
medicines, such as assafcetida, musk, castor, camphor, etc. 
Should there be severe pain, an injection of a gill of thin 
starch with a teaspoonful of laudanum and a little cam- 
phor, will generally give relief; or if it be complicated 
with hysteria, the use of three teaspoonsful of tincture of 
assafcetida, instead of the camphor, may be useful. If 
there is colic (after bleeding, should the pulse have indi- 
cated it) the most certain relief will generally be found, by 
half ounce doses of the tincture of aloes and myrrh, every 
three hours, in warm sweetened milk, till the bowels are 
open. (Dewees.) 

Upon the approach of the next period, great attention 
should be given to the patient, and every means used 
likely to facilitate the natural secretion. The bowels 
should be kept open — the surface comfortably warm, and 
the hip, or foot bath, used alternate nights. The strength; 
if necessary, must be supported by a generous, but not 
stimulating diet. 

If, at the proper time, the menses be re-established, our 
object will be accomplished ; but, if merely a white dis- 
charge appear in its stead, we must again, during the 
interval, put into action all those means mentioned under 
division second, of the tardy appearance of the menses. 

be taken every half hour. Dry cupping to the loins and upper part of 
the thighs may, also, be applied with advantage. 



106 SUPPRESSION OF THE MENSES — SYMPTOMS. 

(See Chapter II., Part IV.) If the white discharge persist 
during the interval, it must be treated simply as leucor- 
rhea, (see that chapter.) But if no discharge appear, 
neither red nor white, recourse must be had to those means 
mentioned in Chapter II. Part IV., and to those remedies 
soon to be enumerated for chronic suppression, according 
to the condition of the patient. 

2. Chronic suppression of the menses may be the con- 
sequence of an acute attack, from neglect or impossibility 
of cure, or it may arise from gradual depression of the 
bodily powers, from causes before mentioned, giving rise 
to delicate health. It may also arise from diseases of the 
ovaria, uterus and other parts of the body, as inflammation, 
induration, ulceration, hydatids, etc., of the uterus and its 
appendages ; anteversion, retroversion, and incomplete 
prolapsus of the womb. It may also be produced by 
pulmonary consumption, disease of the heart, scrofula, 
particularly of the bones, inflammation of the brain, the 
spinal marrow, the stomach, the spleen, the liver, the lungs, 
the pleura, the peritoneum, and any irritation in the sys- 
tem which retains the blood and prevents it from being 
directed upon the uterus. 

The quantity of the secretion may gradually diminish, 
and the time become irregular and uncertain, till at length 
the uterus altogether ceases to act ; or, winch is perhaps 
more frequent, the menses diminish in quantity and become 
of a paler color, with shorter intervals, until leucorrhea 
becomes permanently established in its stead. 

The symptoms which arise from chronic suppression are 
various, being often the same (though less marked) as those 
mentioned under acute suppression. The features of the 
young woman, heretofore brilliant with freshness and 
health, are observed to assume the impress of feebleness, 
depression, and languor ; the roses upon the countenance 
fade; the fire of her eyes is extinguished, and a dark 
circle surrounds them ; finally, the most frequent symp- 
toms are, habitual headache, dyspnoea, dizziness, pains 
in the back, sides, limbs and joints ; deficient appetite, and 
a genernal failure of the vital powers, ending in a con- 
firmed state of ill-health. The moral alteration is, also, 
great ; sometimes there is an excessive sensibility, which 



SUPPRESSION OF THE MENSES — TREATMENT. 107 

renders the female impatient and irascible ; at others, her 
ideas are sad, her imagination is sombre ; sometimes the 
patient seeks for solitude, and sheds causeless tears ; again, 
on the contrary, she becomes passionately fond of music, 
and amusements of all kinds. The general health rarely 
suffers before three or four successive periods have passed, 
unless it be accompanied by considerable leucorrhea. 

If the menses do not occur after suckling, and the 
health of the individual appears to suffer, an examination 
should be instituted to ascertain the state of the parts. 
There may be an obstrustion or obliteration of some por- 
tion of the canal in the neck or mouth of the uterus, or 
of the vagina, in consequence of inflammation following 
delivery. The introduction of the finger will satisfy as 
regards the vagina, but the permeability through the neck 
of the uterus, can only be determined by passing up a 
moderate sized bougie (a slender gum elastic instrument). 

Some care is necessarv to distinguish between chronic 
suppression and pregnancy ; as the patient, if she be in a 
situation to have children creditably, may mistake the sup- 
pression for the first symptoms of pregnancy. The arrest 
of the menses, occasioned by conception, is shortly follow- 
ed by the morning sickness, and an alteration in the breasts, 
etc. (see pregnancy, Book II.) 

Treatment. — The remedies for this form of suppres- 
sion, will vary according to the cause which has given 
rise to it, and the state of the system. When it is conse- 
quent upon disease of the genital system, or of some other 
part, we shall find that, upon the patient's recovery from 
such disease, the menses will generally return. When 
the menses have been superseded by leucorrhea the pro- 
per treatment of it will generally restore the uterine 
functions. 

The reader will particularly notice from what we have 
heretofore remarked upon this point, that every deviation 
in regularity is not i*, legitimate reason for medical inter- 
ference ; in many cases, with young girls, especially those 
who began precociously to menstruate, there will be a 
want of regularity in return, that must not be mistaken 
for disease. So, also, it may happen with hale, robust 
young women, that a temporary suspension takes place 



108 SUPPRESSION OF THE MENSES TREATMENT. 

from cold, passions or emotions* of the mind, which, after 
a certain time, will return without medical treatment. 
The rule on this point should always be, never interfere, 
unless there be some evidence that the health is suffering 
from the absence of this discharge. 

In chronic suppression, the general health rarely suffers 
so as to require medicine, before three or four successive 
periods have passed • up to this time, we should do well 
to put in requisition those hygienic means mentioned in 
Chapter VI., of Part III., for regulating the diet, habits of 
the patient, etc. If we find that the'pulse manifests a ten- 
dency to excess of action, the treatment should be com- 
menced with such^ remedies and regimen as will reduce 
it to a proper standard, before we proceed to the adminis- 
tration of those medicines which have a direct tendency 
to produce the menstruous discharge ; such as small bleed- 
ings, or the application of leeches to the vulva, or dry 
cupping of the loins ; by purging and by a strict vegeta- 
ble diet. Under such circumstances, senna and salts an- 
swer as good a purpose as any other purge. 

After having, with great care, in this manner prepared 
the system, and ascertained that no organic disease of the 
uterus or other parts exists, we may resort to those reme- 
dies known as specifics. The madder should be given as 
recommended in Chapter II., of Part IV., for tardy ap- 
pearance of the menses ; should this fail, resort may be 
had to the tincture of cantharides, as there directed, or to 
the volatile tincture of guaiacum, which, according to Dr. 
Dewees, has succeeded when all other remedies have 
failed. It is more stimulating than the others — therefore 
more care is necessary to have the system properly pre- 
pared for its exhibition. The mode of using it, is a tea- 
spoonful every morning, noon and evening in a wine-glass 
full of sweetened milk ; the dose must be gradually in- 
creased, when a prolonged use is necessary. Should it 
disturb the bowels too much, a few drops of laudanum 
may be added to the dose ; but if on the contrary they 

* A lady in the country informed us that while menstruating she was 
much frightened, while riding in a carriage, by the running of the horse; 
and from that moment the discharge was suspended, which did not re« 
appear till the next period. 



SUPPRESSION OF THE MENSES TREATMENT. 109 

should not be sufficiently opened, the addition of a little 
rhubarb will be an improvement. At the same time that 
these remedies are used, currents of electricity from an 
electro-magnetic machine, may be passed through the pel- 
vis daily, or it may be applied alone. 

Upon the use of electricity, in suppression of the men- 
ses, we find the following in Copland's Medical Dictionary, 
added in a note by the editor : " Galvano-electricity, or 
electro-magnetism, deserves more particular attention as 
an emenagogue remedy. We have succeeded in some 
chronic cases of amenorrhea, that had resisted all other 
means, by daily sending a current of electricity through 
the uterus, or by inserting one conductor in a tub of warm 
water, in which the feet were immersed, and applying the 
other over the cervical vertebrae, thus transmitting the 
fluid through the spinal axis. Dr. Ashwell states, that 
Dr. Goldincr Bird has recently employed the same remedy 
with extraordinary success in the treatment of out patients 
at Guy's Hospital (London.) In some of the cases, where, 
after the condition of the alimentary canal had become 
healthy, the amenorrhea continued with slight pallor and 
weakness, electric shocks passed through the loins, quickly 
induced menstruation. In others, its continued repetition 
three or four times a week, led to a similar result ; and 
instances were not wanting, when a shock suddenly pro- 
duced the flow. It is. however, a powerful remedy, and 
should be employed cautiously, lest it may depress the 
nervous system, and thus protract the disease ; when mod- 
erately applied, it often rouses into activity the energy of 
torpid organs and parts ; but, when used in excess, it may 
altogether destroy their excitability. It should not be 
emplo\ ed in cases of local congestion or general plethora, 
nor during pregnancy, and' it should seldom be used 
alone." 

By referring to the chapter on the physiology of men- 
struation, it will be observed, that according to the late 
theory of menstruation, the efficient cause of this periodi- 
cal discharge, is to be found in the ovaria : that there is 
a monthly evolution or ripening and discharge of an ova?, 
upon which this function depends. Deranged menstrua- 
a 3 then, it would seem, must depend more or less upon 



110 SUPPRESSION OF THE MENSES TREATMENT. 

some irregularity of the ovaria. Indeed, it is found ill 
suppression, that the flow may often be re-established by 
remedies applied to the groins, over the ovaries ; such 
as simple frictions, stimulating poultices and liniments, 
leeches or small blisters, etc. 

Other remedies have been used with success, such as 
iodine in the form of syrup or compound tincture, which 
is particularly adapted to scrofulous constitutions ; the 
various preparations of iron ; the ergot of rye which should 
always be used with great caution, in doses of from five to 
ten grains of the powder, two or three times a day ; and 
strychnine, first used for this purpose by Dr. Bardsley of 
England, and applied by 'him with great success — the dose 
is one tenth of a grain three times a day, to be gradually 
increased to one fourth of a grain ; it must be suspended 
for some days if it give rise to headache or twitching of the 
muscles. Aloes and myrrh, turpentine, savine, sulphate, 
carbonate and citrate of iron, are all useful when judi- 
ciously applied. 

Very few of these remedies, except the preparations of 
iron and iodine, are applicable in the suppressions of feeble, 
nervous women, of a scrofulous constitution, or lymphatic 
temperament — until means have been first made use of to 
improve the general health. Directly contrary to the 
condition before spoken of, when there is excess of action, 
and the system is prepared for them by antiphlogistic 
remedies in this, there is want of action and vitality, and 
the system must be prepared for them by such remedies 
as gradually raise the powers of life. All those means 
before mentioned must be put in requisition — a nutricious 
and stimulating diet, with a cautious use of wine, hip and 
foot baths, attention to the happy influences of cheerful 
and varied society and scenes, music, dancing, etc. 

This process may be very much assisted by the use of 
tonic medicines ; the various preparations of iron, and 
iodine, seem to be best adapted for this purpose. Of the 
former, the best, are carbonate, tartrate, lactate, and citrate 
of iron, in the dose of eight or ten grains of any one of 
them, combined with bitter extracts or infusions, as of 
columba, gentian, quassia, and dandelion. Of the latter, 
the best form is that of the tincture of iodine in combina- 



SUPPRESSION OF THE MENSES TREATMENT. Ill 

tion with the iodide of potash — dose, from ten to twenty 
drops, three times a day, to be increased. This is particu- 
larly applicable, as we have remarked, in those of scrofu- 
lous constitution. When the general health becomes 
improved without any effort on the part of the uterus to 
re-establish its function, a resort must be had to the reme- 
dies mentioned above for this purpose. 

As a last resource for the girl laboring under obstinate 
suppression of the menses, marriage has been recommend- 
ed by eminent physicians from the time of Hippocrates 
downwards — though of late with less confidence than for- 
merly. Simulating the plan of cure by the animating 
influence of love and the physical effects of a rational 
indulgence of the desires, by which the species is re-prc- 
duced, has been originated an artificial irritant by injection 
of a solution of ammonia into the vagina. Dr. Lavagna, 
the originator, remarks : " There is hardly a physician, 
however limited his practice, to whose lot it has not fallen 
to observe young females, who, at the age of puberty, 
were dull, languid, pale and laboring under scanty men- 
struation, suddenly restored to bloom, animation and vigor, 
and to the salutary sanguineous evacuation, by an oppor* 
tunity being afforded them of participating in conjugal 
duties. Whenever I reflected on this fact, and considered 
the numerous cases by which it was established, T never 
doubted that any stimulating medicine which might have 
the effect of determining an increased sanguineous afflux to 
the matrix, (uterus) would succeed in exciting suppressed 
menstrual evacuations." The mode of use, is, to throw 
up the vagina, by means of a female syringe, ten drops of 
pure water ammonia in an ounce of warm milk or water, 
several times a day. According to his account, the action 
of the ammonia was very prompt in relieving many cases 
of suppression. 

Another remedy has been proposed and applied with 
success, viz : stimulating the external surface of the 
mamma, with sinapisms, a few leeches or slight blisters. 

In the chronic form of suppression, when practicable, 
we should always direct a residence in a fresh and dry 
atmosphere, a mountainous country is preferable, the use 
of nourishing food, such as rich soups, light meats, etc. ; 



112 VICARIOUS MENSTRUATION. 

bitter infusions and gently excitant drinks ; mineral 
spring waters; dry frictions ; flannel next to the skin; 
cold bathing and swimming ; exercise on foot, in a carriage, 
on' horse-back ; a variety of games, jumping, dancing, etc. 
We should remark in conclusion, that the moral condition 
of the patient merits as close attention as the medical treat- 
ment. If we neglect to attend to the state of the mind, 
menstrual disorders depending upon certain mental condi- 
tions, as profund dejection, resist all the resources of the 
healing art; they are mostly powerless in opposing the 
suppression of a young girl who is tormented by a disap- 
pointed or unfortunate love ! 

It is to the persuasive eloquence and counsels of friend- 
ship, the consolations of a prudent, enlightened mother, and 
especially the gratification of the affections by marriage, 
when there is not extreme prostration, that we are to look, 
in these cases, for arresting the disease at its source. 



CHAPTER IV. 

VICARIOUS MENSTRUATION NATURE, CAUSE AND TREATMENT. 

In cases of suppressed menstruation, where the monthly 
menstrual effort occurs, without secretion on the part of 
the uterus, and where the system generally is suffering 
from the consequent plethora or irregular distribution of 
blood, an attempt is made by the natural powers to afford 
relief by a discharge of blood from some other part ; gen- 
erally, one which is already diseased or enfeebled. This 
is called vicarious menstruation ; and has taken place from 
the nostrils, eyes, ears, gums, lungs, stomach, armpits, 
bladder, nipples, toes, fingers, from the stumps of ampu- 
tated limbs, from ulcers, and from the surface of the skin, 
generally. The mucous membranes, however, of the 
lungs, stomach and intestines, are the most common seats 
of the discharge. 

This discharge generally comes on suddenly and con- 
tinues at intervals for several days. In most cases it 
seems to relievo the constitutional distress consequent 



EXCESSIVE MENSTRUATION. 113 

upon suppression, but does not favor the natural establish- 
ment of the function during the interval. In general, it 
is not followed by more serious consequences than those 
resulting from the loss of blood. The most dangerous 
form is when it proceeds from the lungs. 

Treatment. — If the attack commenced without previ- 
ous warning, little can be done during the flow. If the 
discharge be from the lungs, or stomach, opium, alone, or 
in combination with sugar of lead may be given, to mode- 
rate the evacuation. (Opium, one grain, sugar of lead, 
two grains.) 

If there be grounds for expecting an attack of this 
kind, means for avoiding it should be at once used, and if 
possible, at the same time, to stimulate the uterus into 
activity. If there be much plethora, one good bleeding 
from the arm; otherwise, cupping over the sacrum, or 
leeches to the vulva, and mild purging, will answer both 
indications at the same time. During the interval, the 
patient must be treated much in the same way as before 
recommended for suppression. 

Where there is debility, tonics, vegetable or mineral, 
particularly the preparations of iodine and iron, should be 
given, in doses before directed ; and if these means are 
not successful, and there are no counter-indications to 
their use, some of those remedies which act more directly 
upon the uterine system may be given. 

When leucor^hea is vicarious of the menses, the treat- 
ment is very nearly the same ; much good is to be expected 
from the exhibition of iron and the bitter tonics, with a 
well-regulated hygiene. 



CHAPTER V. 

MENORRHAGIA, OR EXCESSIVE MENSTRUATION TWO DIVI- 
SIONS—CAUSES SYMPTOMS, AND TREATMENT. 

The term Menorrhagia has been used by some writers 
to signify merely an increase of the menstrual flow, with- 
out any mixture of other fluids; others, include by it all 



114 EXCESSIVE MENSTRUATION DIVISIONS. 

discharges of blood which may acompany or succeed the 
menses. We shall follow the latter signification, without 
including those floodings and uterine hemorrhages con- 
nected with pregnancy and parturition, which will be else- 
where considered. 

Excessive menstruation may occur in. various ways; 
the menses may return too frequently or too copiously, or 
at unusual periods. The nornial quantity of fluid dis- 
charged at each monthly evacuation varying in different 
women, this condition only exists when there is a dispro- 
portion between the loss and the power of replacing it. 
It is the relative qantity lost, and not the absolute, which 
constitutes the disease ; so that seeming derangement should 
only be considered excessive menstruation, when it has an 
injurious effect upon the general health. 

We shall include every variety of the disease under 
two divisions, which have reference principally to its 
severity. In the first, although the discharge may be 
considerable, and occasionally mixed with clots of blood, 
there is no change in the condition of the mouth of the 
uterus. In the second, there is great loss of blood, with 
a marked change in the size and condition of the mouth 
of the uterus, from the severity of the disease. 

1. In the first division, it often commences with a sud- 
den gush from the vagina, after which, it may stop for 
some hours, and then recur; and this alternation may 
continue during the usual period of menstruation. On 
the other hand, sometimes the discharge goes on regularly, 
but instead of being over in three or four days, lasts for ten 
days, or a fortnight, or even three weeks ; or it may return 
in usual quantity every two or three weeks; this variety, 
more frequently than the other, is connected with that state 
of the lining membrane of the uterus which gives rise to 
leucorrhea. 

In this condition, there may be more or less discharge 
of clots of blood along with the proper secretion, though 
it rarely occurs in young or unmarried females. The 
subjects of it are generally women of the leucophlegmatic 
temperament, whose constitutions have been impaired by 
disease, or frequent child-bearing. One or two small clots 
appear at first, with an'interval, and then return in in- 



EXCESSIVE MENSTRUATION SYMPTOMS, CAUSES. 115 

creased quantity. It is not known in these cases whether 
the discharge is altered in quantity or quality. 

The symptoms, are languor, exhaustion, weakness 
across the loins and hips, paleness of the countenance, 
headache, ringing in the ears, and giddiness ; these occur 
more or less in the slighter cases. If the disease continue, 
and especially if leucorrhea be present, all these symp- 
toms become very much aggravated — the languor in- 
creases, the face becomes sallow, there is an aching pain 
across the loins, extending round the abdomen, repeated 
and severe headaches, derangement of the stomach and 
bowels ; finally, there is extreme exhaustion with a feeble 
pulse, melancholy, nervous symptoms, ending in dropsy 
and even epilepsy. 

The causes of this disease are often the same as those 
enumerated as giving rise to suppression, and other derange- 
ments of menstruation — though they here act in a different 
way, viz : errors of physical education ; the bad results of 
an ill-regulated diet ; want of proper ventilation ; and the 
depressing influences of grief, terror, etc. Anything 
which determines the blood to the uterus in undue quan- 
tities, acts as a cause — as heated rooms, too much cloth- 
ing, warm bathing in excess, etc. 

A prominent cause, in this physic-taking community, of 
this disease, as well as of many other ills in both sexes, is 
the enormous consumption of quack pills and potions of 
every variety. These so called medicines for the most 
part contain ingredients that operate violently upon the 
lower part of the intestines, near the uterus, and thus de- 
termine an excessive quantity of blood to that organ, besides 
debilitating the bowels and frequently producing piles. 

Of the causes, at a more advanced period of life, child- 
bearing, and over-suckling are perhaps the most frequent ; 
the latter is often carried to a great extent among the poor, 
for the purpose of preventing a too rapid increase of the 
family ; which it does very effectually, when it gives rise 
to this disorder, but at the expense of much suffering, and 
loss of health to the mother. Excessive coition sometimes 
causes, and always aggravates, this affection. 

In the severer cases of this disease, conception does not 
take place, but it may in the milder ones. The disease 



118 EXCESSIVE MENSTRUATION TREATMENT. 

may or may not return after delivery. There is always 
a great liability to abortion, if the patient become preg- 
nant, and also from the relaxation produced, a disposition 
to prolapsus of the uterus and vagina. (See chapter on 
prolapsus.) 

Treatment. — The first indication, is to remove the 
cause, if possible. If it proceed from over-suckling, the 
child should be immediately weaned, and the patient 
should live for some time absque marito. 

During the attack, in persons of a full habit of body, 
and when the affection is recent, it may be necessary to 
cautiously take blood from the arm, cup the loins, or ap- 
ply leeches to the anus. The patient should repose con- 
stantly in the horizontal position upon a mattrass with the 
hips elevated. The drinks should be cold and refreshing, 
such as water, lemonade, mucilages or whey, decoction 
of rice with nitre, of apples, oranges sweetened, syrup of 
currents, mulberries, cherries, quinces, etc. When the 
discharge is copious, a dose of opium, or the sugar of 
lead in combination with opium, will often diminish the 
quantity ; one grain of the opium, or a half grain with 
two grains of the lead, may be given at a dose, to be re- 
peated once in an hour or two, if necessary. When these 
remedies have not succeeded, the ergot of rye, given in 
five grain doses, three times a day, has seldom failed. 
Other astringent medicines internally have been recom- 
mended, such as large doses of sulphuric acid, (ten to 
twenty drops) largely diluted in infusion of roses, decoc- 
tion of logwood, of the roots of black current and the roots 
of the dewberry, etc. 

In severe cases, cold to the vulva has been found very 
useful, either by cloths wrung out of ice water, or by its 
being poured from a height upon the hips and abdomen ; 
during these applications the feet should be kept warm. 
Vaginal injections of cold water and astringent solutions 
have been recommended, but should be used with great 
caution during the attack ; and as a last resort, plugging 
the vagina ; — if used, the plug should be removed in ten 
or twelve hours, and if necessary, a fresh one may be in- 
troduce d. 

This is the mode of treatment during the attack ; much 



EXCESSIVE MENSTRUATION TREATMENT. 117 

may also be done during the intervals by local and general 
remedies and a prudent regulation of the diet. It is of 
the greatest importance that the bowels be kept open, 
which must be done mostly by a laxative diet ; as stewed 
fruits, bran bread, etc. A blister may be kept on the 
loins with great advantage ; vaginal injections, at first of 
tepid and afterwards of cold water, will be found useful. 
The distressing weakness of the loins may be much re- 
lieved by daily sponging the lower parts of the body with 
cold salt water. 

Tonics, especially the mineral ones, should be given, as 
directed in the last chapter. The muriated tincture of 
iron, as well as the carbonate, will be found particularly 
useful. The food, in the sanguine temperament should 
dp exclusively vegetable. Tea and coffee, with every 
kind of warm drinks, sleeping on feather beds, foot stoves 
and stimulating food and drinks, should be avoided. In 
the lymphatic temperament, the food may consist of fish 
and fowl ; even porter and wine may often be given with 
advantage. Every kind of excitement of the uterine sys- 
tem must be avoided. The invalid should live in a dry 
atmosphere, and very moderate exercise should be taken 
throughout the interval. No melancholy companions 
must be allowed with the patient, and all mental emotions 
should be carefully avoided. 

2. In the second division of excessive menstruation, the 
discharge is more profuse, and its effects more severe, than 
in the first ; it is accompanied by alterations in the condi- 
tion and size of the mouth of the uterus; occurs at a later 
period of life, and is more difficult of cure. 

The attack commences much in the same way as in the 
former, though generally not so suddenly : it is not con- 
fined to any particular kind of temperament, although it 
occurs more often in the sanguine, than in the debilitated, 
or melancholic. This form rarely appears under the a^e 
of forty, or after the cessation of the menses. There is, 
for some time previous to the attack, irregularity, as to 
time, quantity, and duration of each menstrual period, 
with occasional leucorrhea during the intervals. When 
the menses have flowed naturally for about twenty- four 
hours the bloodv discharge apDears ; large clots are now 
6* 



11.8 EXCESSIVE MENSTRUATION CAUSES. 

expelled, and there is a great increase in the fluid dis^ 
charged. The attack at first lasts but eight or ten days ; 
- but in long standing cases, it has been known to continue 
during the interval. The quantity lost is some times very 
large, producing excessive exhaustion, and weakness of 
the loins. It is accompanied with a sense of weight and 
pain in the pelvis, and difficulty of discharging the urine. 
The general health of course suffers much — the bowels 
become constipated, the face blanched, and the strength . 
much reduced. 

Exactly what change always takes place in the uterus, 
or its vessels, is not known. Upon examination its mouth 
is found lower in the pelvis, the neck is more or less swollen 
and is tilted forward so as to press upon the bladder, thus 
producing the above named symptom in that organ. 
There is sometimes tenderness upon pressure in the neek 
and body of the uterus, the vessels of which, are evidently 
very much congested, or engorged with blood. So that 
the discharge is not the result of secretion, but of the rup- 
ture of some of the vascular twigs, which ramify on the 
lining membrane of the uterus. The disease, unless the 
organic changes be considerable, is not generally very 
obstinate; it may subside in consequence of remedies, or 
spontaneously, in two or three months, or it may continue 
for two or three years. 

The causes are often the same as those mentioned as 
producing the first kind. Women who live indolent lives, 
with little or no exercise ; who are intemperate in the 
use of stimulants, hot drinks, as tea and coffee ; who 
dance inordinately and keep late hours ; who are too prodi- 
gal of the joys of wedlock, and have borne many children ; 
who are in the habit of tight lacing, and who yield too 
3*eadily to passions and emotions of the mind, are those 
most subject to this disease. 

This kind of excessive menstruation is easily distin- 
guished from the flow of blood, dependent upon organic 
diseases of the uterus, as corroding ulcer, cancer, polypus, 
etc., by the irregularity of its occurrence in those diseases, 
and its persistence after the usual period of this excretion 
has expired. 

Treatment. — At first, all those means mentioned for 



EXCESSIVE MENSTRUATION TREATMENT. 119 

the treatment of the first kind, may be tried. If the opium 
and lead fail, as they frequently will in this form, as well 
as the application of cold as there directed, and plugging 
the vagina — the ergot of rye must be mostly relied upon ; 
in short, it seems to be the only remedy which has the 
power of controlling this discharge. It may be given in 
doses of five or ten grains, two or three times a day. Du- 
ring an attack, the patient should be kept in a perfect state 
of rest — on a hard mattrass, covered rather lightly with bed 
clothes. All her drinks should be cool and unstimulating 
unless she become faint, when a little wine or brandy may 
be allowed. At the same time that the ergot is given, cold 
must be persevereingly applied over the lower part of the 
abdomen, by cloths wrung out of ice-water, or the douche. 
The precaution of keeping the feet warm, should always 
be attended to. If the discharge be not arrested, it is a 
question how far we should be justified in the use of vagi- 
nal injections of cold water and astringent solutions. Some 
authors have highly recommended them, but they would 
seem attended with danger during the period of attack. 

As soon as the discharge ceases, not a moment should 
be lost in the employment of remedies for the cure of the 
disease. Dry cupping to the loins, and the application of 
a blister, which is to be kept open, or repeated, are always 
useful ; they relieve the pain in the back, and diminish 
the white discharge. But the most powerful means which 
we possess, at this stage, are vaginal injections of cold wa- 
ter and a solution of sugar of lead, and other astringents, 
two or three times a day. An almost immediate improve- 
ment is perceptible ; the swelling of the uterus becomes 
less, the leucorrhea disappears, and the patient is soon able 
to walk without inconvenience. 

The patient is always liable to relapse ; consequently, 
one or two menstrual periods should be passed, notwith- 
standing the great improvement, with rest and great cau- 
tion, before she resumes her usual duties. Should a re- 
lapse unfortunately occur, the symptoms must be again 
mi't by the same remedies. 

During the intervals, the same treatment must be pur- 
sued, as directed under the first form of this disease. The 
bowels must be kept free, at the same time, purging shoul I 



120 EXCESSIVE MENSTRUATION TREATMENT. 

be avoided. Tonics, as before directed — iodine in scrofu- 
lous constitutions, and iron in all others, are peculiarly 
beneficial. We may, also, employ with benefit, the mine- 
ral spring waters, decoction of catechu or kino, extract of 
cinchona and columbo. A nutritious diet may be allowed, 
and if the patient be much weakened, porter or wine. 
Moderate exercise in the open air, will be very service- 
ahlo, while all causes of excitement, especially of the ute- 
rine system, must be studiously avoided. For some time 
the patient (if married) should live absque marifo. 

Women who wish to moderate a too great abundance of 
the inrnses, should abstain, during the period of their flow, 
from all violent exercises, and sometimes even maintain a 
horizontal position, in such a way that the pelvis may be 
rather more elevated than the head and trunk : those of 
strong constitution should make use of a milk and vege- 
table diet; of diluent, cooling and acidulated drinks — as 
currant water, whey, weak lemonade, decoctions of barley 
or dog's grass with nitre, mucilage of gum Arabic, flavored 
with lemon syrup or with vinegar. Women of a nervo- 
lymphatic temperament, must be nourished with tonic ali- 
ments, principally roast meats, and they ought to use for 
drink, during their repasts, water mixed with a little gene- 
rous wine. There might, also, be directed for them with 
advantage, narcotics and antispasmodics, administered in 
minute doses during the continuance of the function; the 
use of cool, or, if the season forbid, of warm baths, in 
the interval ; in either case, small revulsive bleedings from 
the arm,, a few days after the menstrual discharge, to be 
repeated between each periodical epoch, will contribute 
powerfully to moderate the discharge of blood from the 
uterus. 



CHAPTER VI. 

DYSMENORRHEA, OR DIFFICULT AND PAINFUL MENSTRUA- 
TION SYMPTOMS— CAUSES, AND TREATMENT. 

The most prominent and distinctive mark of this disease 
is the pain. We may have scanty menstruation as we have 
seen in " suppression." or profuse, as in " excessive men- 
struation," and sometimes about the usual amount, but in 
addition, severe pain attending the secretion and discharge 
of the menses. It is characterized on each return of the 
monthly period, by successive pains in the loins, com- 
mencing a few days before, or just previous to the men- 
strual eruption ; it may occur only for a few periods, but 
occasionally continues throughout the whole of menstrual 
life. 

The pains vary much in character and intensity, accord- 
ing to the consititution of the individual ; they may be 
moderate and lasting but a few hours each time, or they 
may be so agonizing as to cause fainting. The stomach 
and bowels become irritable, producing vomiting, or diar- 
rhea, with scalding of urine ; or, in the severer forms, the 
nervous system may become much disordered, giving rise 
to hysterical convulsions, and even catalepsy. These 
symptoms suddenly or gradually cease upon the eruption 
of the menses. 

This disorder may be divided, according to the consti- 
tution of the individual, into two species, — the inflamma- 
tory, when it occurs in females of a full habit and san- 
guine temperament, — and the neuralgic, when it is con- 
'fined to those of a nervous temperament and of a thin, 
delicate habit of body. A third kind may be added, when 
there is a mechanical difficulty and it arises from some 
impediment in the passage leading to the uterus. These 
distinctions are only important in the treatment, as the 
causes are generally the same. 

Symptoms. — This disease may attack females at any 



122 PAINFUL MENSTRUATION CAUSES. 

age, and is more commonly observed in unmarried women, 
and in married women who have never borne children. 
For a day or two previous to the monthly paroxysm, there 
is a general sense of uneasiness, feelings of cold, and 
headache which alternates with the pain in the back ; the 
latter pain is often severe and of a bearing down charac- 
ter, simulating that of labor. In plethoric constitutions, 
there is frequently a flushed face, hot skin and full pulse. 
In all, there may be severe pain, which is mitigated when 
menstruation becomes fully established. The period be- 
tween the commencement of the pain and the flow of the 
menses, is very uncertain ; it may be but a few hours, or 
it may be a day or two. 

When the menses appear, sometimes the eruption is 
slow and scanty, at others it is in slight gushes. The dis- 
charge may be unchanged, but frequently we find it paler 
than usual, or mixed with small clots of blood. In many 
cases there is a peculiar membrane discharged, which is 
supposed to be secreted by the lining membrane of the 
uterus ; it generally has the form of the cavity of that 
organ, although it may be discharged in shreds. The dis- 
charge of this membrane by the unmarried, has sometimes 
given rise to unjust suspicions of conception. Its expul- 
sion is accompanied by severe pains, resembling those of 
labor. Dr. Denman regarded the secretion of this mem- 
brane as a mark of sterility, and says that he never knew 
a* female conceive in whom it was formed. Subsequent 
observation informs us, that, although conception is not 
impossible, it does. not often take place. 

The causes of this form of menstrual disorder, though 
various, do not seem to be connected with any derangement 
of uterine structure. They are often the same as those 
repeatedly enumerated as giving rise to other irregulari- 
ties of this function, and in general, all such as excite the 
nervous system, and more especially, such as exalt the 
sensibilities of the uterus, as the emotions of terror and 
joy, have been known to produce it; it has, also, been 
known to follow the consummation of marriage. Perhaps 
the most common cause is cold, taken during menstrua- 
tion, or soon after miscarriage, or delivery. These may 
give ri«e to sudden contractions, which, in some cases, if 



PAINFUL MENSTRUATION TREATMENT. 123 

unrelieved, may produce hardening and alterations in the 
neck and mouth of the uterus ; thus giving rise to barren- 
ness and a disposition to cancer. The majority of cases 
are curable, although a few resist all the known means of 
alleviating the malady, and are only cured when the func- 
tion of menstruation ceases. 

Treatment. — The requisite treatment is applicable to 
the period of attack and the interval* 

At first, we must administer such medicines as relieve 
pain ; and our principal reliance is upon sedatives, as opi- 
um, camphor, etc. Opium may be given in grain doses, 
every second hour, commencing with the first pain in the 
back and continuing until relief be obtained. Camphor 
may be combined with opium, or given alone. If the opi- 
um should disturb the stomach, it may be given in form of 
laudanum, in a glyster of starch, or mucilage of any kind. 
If the patient be plethoric, and feverish, we should at the 
same time extract blood, by cupping the loins, or by ap- 
plying leeches to the thighs ; the bowels may be moved 
by saline purgatives, and cooling drinks exhibited. Care 
should be taken lest the amount of depletion altogether su- 
percede menstruation. If the head be affected by the 
opium, morphine, hyosciamus, or conium may be substi- 
tuted. The liquor acetate of ammonia, in doses of from 
a half to a table-spoonful, properly diluted, once in three 
hours, will be found particularly serviceable when there 
is fever. Warm local applications, or the warm bath, will 
be found very serviceable. Drs. Dewees and Gooch gave 
with success, the ergot, in five grain doses, three times a 
day, two or three days before the expected attack. Electro- 
magnetism, -also, may prove beneficial in giving relief. 

During the interval, every effort should be made to 
strengthen the patient, and lessen the local and general 
irritability, as repeatedly recommended in other forms of 
menstrual derangement. The diet should be generous ; 
with wine, if there be much debility ; and exercise in the 
open air should be taken daily. A blister or caustic issue 
to the sacrum, is often very useful, and much benefit may 
be derived from the daily use of vaginal injections of tepid 
or cold water, till the approach of the next period, when 



124 PAINFUL MENSTRUATION — TREATMENT. 

warm water must be used ; and for two or three nights 
previously, the patient should take a hip or foot bath. 

One chief reliance during the interval, for medicine, 
must be placed upon tonics, as the preparations of iron, 
etc. A good mixture is, equal parts of wine of iron and 
Hoffmans' anodyne liq., of which, from a half to a tea- 
spoonful, may be taken two or three times a day. Dr. 
Dewees relies most confidently upon the tincture of guaia- 
cum, in doses of half a tea-spoonful three times a day. 
For a change, some of the vegetable tonics may be admin- 
istered, as gentian, quassia, cascarilla, etc., combined with 
senega. The bowels must be kept free, with mild purga- 
tives, and if any return of symptoms show themselves, 
upon the approach of the monthly period, cupping the 
loins may be useful in warding off the attack. 

The treatment of painful menstruation of the mechani- 
cal species — caused by a narrowing or stricture of the 
neck of the uterus, from inflammation or malformation, 
must consist in dilating the stricture by the cautious intro- 
duction of elastic bougies. During this operation, the 
patient may be upright, or in bed. One of a small size 
should be commenced with, gradually increasing till one 
can be passed the size of a male catheter. The instru- 
ment should be allowed to remain a few minutes at a time, 
and its frequency of use must depend upon the irritability 
of the patient ; — two or three times a week will be often 
enough. It will be well to use daily vaginal injections 
of warm water, and if necessary, the patient must be kept 
under the influence of sedative medicines, with an occa- 
sional mild cathartic. It is perhaps unnecessary to say, 
that no force should be used in passing the instrument. 



CHAPTER VII. 

DECLINE, OR CESSATION OF MENSTRUATION- — CONSTITUTIONAL 

EFFECTS TREATMENT, WITH HYGIENIC RULES FOR WOMEN 

AT THIS PERIOD. 

If at her introduction to the menstruating period, woman 
is calculated to enlist our sympathy, the circumstances 
attending its final departure, are still more adapted to ex- 
cite our earnest desire for her welfare. In youth, she is 
surrounded with scenes that please the fancy and excite 
the imagination, and has neither judgment nor precedent 
to guide her anticipations of good or evil. During the 
period in which she is fulfilling the great object of her 
being, she is occupied by the cares and joys of domestic 
life, and has neither leisure nor desire to reflect upon the 
approach of that important change, in which she is to 
undergo the anxieties of a transition to the closing phase 
of her existence. But when that period approaches, her 
apprehensions are often painfully excited : it is, indeed, 
her " critical period." Whether she is to enjoy the re- 
mainder of her life, free from some of the severer diseases 
incident, to her sex, or to sink under their accumulated 
force, when nature has been too severely taxed in youth 
to retain power enough to repel them, depends much upon 
the manner in which she has passed through the child- 
bearing period. — Dixon. 

We have before stated that, as a general rule, the period 
during which woman is capable of bearing children, ex- 
tends from about the fourteenth or fifteenth, to the fortieth 
or forty-fifth year, depending much upon the constitution 
and habits of the individual. The nearer a woman ap- 
proaches the latter named period, all other things being 
equal, the greater her liability to menstrual irregularity. 
We have remarked that females delicately brought up, 
whose nervous systems have been prematurely excited by 
habits of a certain kind, menstruate earlier than others ;. 



126 DECLINE OF THE MENSES PHENOMENA. 

such persons, also, arrive earlier to the period of the cessa- 
tion of this function than those of a contrary constitution and 
habits, without any injurious consequences following. In- 
deed, many such individuals are never free from seveie 
suffering till this change of life exempts them from irregu- 
larity of the menses. On the other hand, we find many 
cases on record, in which this discharge continued regu- 
larly much longer than the usual period ;* till beyond 
even the seventy-fifth year. 

The occurrence of incapacity for child-bearing in the 
female at this time of life, seems to be founded in the 
highest wisdom and beneficence. Besides being incapa- 
ble at this age of transmitting perfection of organization 
and vigor to her offspring — the mother, not being able to 
extend her care to the child, would be obliged to leave it 
to the management of strangers, at a time when its help- 
lessness would most require a mothers devotion to its 
necessities. 

Sometimes the " change of life" is so silent in its ap- 
proach, that the woman scarcely notices the change in 
her condition ; at others the approach is so gradual that 
the diminished quantity first gives warning that the dis- 
charge is about to take its leave forever ; while again, the 
irregularity may be so great, both in time and quantity, 
as justly to give alarm, as well as to produce the most 
serious danger. 

We may remark, as a general rule, that when a woman 
approaches near her forty-fifth year, her menses become 
irregular, both in the period of return, and the quantity 
of fluid evacuated ; being sometimes in advance, and at 
others not appearing until long after the accustomed time. 
There may be also, some alteration in the health ; she 
perhaps becomes pale, debilitated, and nervous. As in 
the commencement, so in the cessation, there is generally 
a gradation ; the courses may return two or three times 
in a month, then cease for a few months, afterwards 
returning with great profuseness ; this state may continue 
for a year, or longer, when the discharge gradually be- 

* M. Orfila has informed us that a woman who had had seven child 
ren, became pregnant of her first child at the age of forty-seven, gave 
biith to her last at sixty, was regular to her ninety-ninth, and died at 114. 



DECLINE OF THE MENSES PHENOMENA. 127 

comes pale, then of a white serous nature — and ceases, to 
return no more. 

Should the menses not have returned foi a few periods, 
the woman may become the victim of illusions ; the most 
common of which is,— as the abdomen and breasts enlarge, 
the appetite becomes capricious, etc. — she may suppose 
herself to be pregnant. But this hope, if it have been 
cherished, is soon for ever destroyed ; for the menses be- 
fore long return in overwhelming quantity. 

At this period she may be said to exchange her own 
constitution for that which is appropriate to the male. The 
womb having laid aside those vital properties which fitted 
it for the act of reproduction, gradually ceases to act upon 
the general economy, and takes its place in class among 
the other organs whence it emerged at puberty. It di- 
minishes in size, becomes more dense, its neck undergoes 
a sort of atrophy, and little by little is effaced ; its mouth 
becomes indistinguishable, or disappears entirely. As the 
blood no longer retains its habitual determination towards 
the organs of reproduction, it flows more freely towards 
the superior regions of the body, when it gives rise to 
vertigo, headache, epistaxis, and hot flushings. The face 
acquires a purplish hue, the eyes are red and injected. 
The pulse being full and bounding, indicates a plethoric 
state ; the beatings of the heart are effected with a sort of 
distress, the respiration is not easy, and the sleep often 
broken by frightful dreams, does not serve as usual to 
repair the wasted strength. In fine, a sort of uneasiness 
and restlessness of the limbs, come to indicate a state of 
great irritability, conjoined with extreme exhaustion. 
The pains that she feels in the loins and in the lower part 
of the abdomen, are accompanied with intolerable and 
vexatious itching about the vulva and fundament. The 
skin rapidly loses its color and suppleness, becomes 
wrinkled and sallow ; the hair falls off or turns grey, the 
breasts, which at first become flaccid and pendulous, at 
length disappear entirely ; the voice changes and resem- 
bles more nearly that of the male, and all the graceful and 
soft contours of the gentle sex disappear, to be replaced 
by a wrinkled surface. 

The moral character of the female is sometimes even 



128 DECLINE OF THE MENSES — PHENOMENA. 

more affected by the change than her physical constitu- 
tion. She becomes sad, restless and taciturn ; she regrets 
her lost power to please ; the enjoyments that are gone 
forever, and the future, which she views clothed in the 
most sombre hues. Some among them, who were always 
good, sweet tempered and patient, become sour, excitable, 
irrascible ; often falling into passion without provocation, 
they become unjust towards every body ; they issue their 
orders with sharp tones, and treat every body about them 
with severity. In others the sensibility increases as it 
did at puberty, and they are pestered with vapours and 
hysterical poroxysms, or, tyrannised by the memory of 
past love, seek to extinguish their ardor in new sources 
of enjoyment. This resurrection of the desires and pas- 
sions almost always leads to bitter remorse, and to the 
most formidable results. 

In spite of the loss of her physical advantages, the aged 
woman who is endowed with sense and wit, and who re- 
nounces all vain pretensions, and lays aside all coquetry, 
finds it in her power, by numerous admirable qualities, to 
become more worthy than ever of the warmest friendship 
and confidence of the male to whom she is a sincere and 
consolatory friend. At this period the qualities of her 
soul are greatly perfected ; the passions that long agitated 
her bosom have purified her heart, which becomes steady, 
so that her friendship is immovable, and capable of the 
greatest sacrifices. Together with a new existence, she 
regains a new dominion over all that surround her, and 
her empire, which was previously circumscribed by the 
narrow circle of a few men, now comprehends within its 
circumferance even the women who have ceased utterly 
to be classed among her rivals. (Colombat.) 

Those women who were always thin and delicate before 
this period, from menstrual irregularities, have the con- 
stitution so completely changed, and so greatly strength- 
ened, that they are restored to the most perfect health and 
elegance of form, which they enjoyed in the spring-time 
of their youthful days. The unhappy victims of a life of 
celibacy, however, those whose lives have been agitated 
by the liveliest passions, by numerous vexations, or excess 
of pleasures, are generally more violently and painfully 



DECLINE OF THE MENSES PHEXOMENA. 129 

shaken, at this crisis, than such as have made a better use 
of their existence. 

Some females as they approach this period, entertain 
the most gloomy, apprehensions of danger from the suppo- 
sition that vicious humors may be retained in the blood ; 
and thus come in requisition " medicines to purify the 
blood," as they are termed, in the form of nostrums, purg- i 
ing pills, etc., which are highly injurious. But females 
should know that all this is very absurd, and only a theory 
of the vulgar. As the menstrual blood is derived from 
the general mass, if one be pure, the other must be so 
likewise. There is a great difference in the cessation of 
this discharge at the proper time, and the suppression of 
it during the menstrual period. In the one instance it is 
a natural process, equally so as its commencement, and 
is effected by the inherent powers of the system ; but in 
the other, the suppression of it, there is a derangement of 
the intentions of nature, which must of course be followed 
by deleterious consequences. 

The common error (for such it is) that there is a great- 
er mortality among females at this period of life, than of 
any others, or among the other sex, is replete with evil, 
and should be exploded. For it appears that fewer women 
die between the ages of forty and fifty, than men, or in- 
deed, at any other period of their lives, after puberty ; 
and further, that if this change be effected without much 
disturbance, that they live not only longer than men, but 
are freer from morbid inconveniences. (Boinision.) 

That they are sometimes liable to a disease at this time, 
and that disease, one of the most terrible in the long list of 
human infirmities, we admit ; but, nevertheless, must in- 
sist that cancer, the disease alluded to, is more rare in 
the uterus, than in certain other portions of the body — for- 
instance the mamma. If latent disposition to disease, 
either in the uterus or other parts, become active about 
this period of life, it is not because the declining menses 
excite them ; but because the disease is slow in develop- 
ing itself, and is, perhaps, kept in check for a long time, 
by the menstrual discharge relieving the engorgement of 
the vessels, which acts, not as a specific discharge, but as 
a mere depletion : or, in other words, that if an equal 

G 



130 T)LCLINE OF THE MENSES TREATMENT. 

quantity of blood could have been by any other means as 
certainly abstracted from the uterus, the same favorable 
result would have followed. (Dewees.) 

If the patient escape the more serious affections, there 
is a liability to seizures of a temporary nature in various 
parts. The most common of these, are hemorrhages from 
different surfaces, local inflammations in delicate parts, 
dizziness, hysterical paroxysms, colic, rheumatism, piles, 
cutaneous eruptions, ulcers of the legs, dyspepsia, leucor- 
rhea, palsy, apoplexy, etc. In extremely rare instances, 
sudden death has occurred at this period. After the sys 
tern has been for so many years accustomed to the men 
strual discharge, even though nature intends it shall cease 
it may be regarded as the somewhat sudden stoppage of a 
constitutional drain, which in other instances is observed 
to have similar results. The degree of danger in these 
attacks, seems to depend upon the abruptness of the men- 
strual cessation. 

Treatment. — Nothing will be so effective at this period 
in guarding the female against the occurrence of danger- 
ous irregularities of the menstrual discharge, as a well 
regulated diet, exercise, management of the passions and 
emotions of the mind, etc. 

Those women who live in the country and are in the 
habit of exercising freely in the open air, and have passed 
the child-bearing period, according to the intentions of 
nature, by suckling their own children ; who do not pam- 
per their systems by luxurious and stimulating food and 
drinks ; who do not relax their bodies by long confine- 
ment in hot rooms, and too long indulgence in bed, have 
little or no suffering at this epoch. 

There are two conditions of this period, which, when 
they occur require particular treatment. First, when there 
is a diminution in quantity of the proper discharge ; and 
second, when there is an excess of it. The first, requires 
to be treated in the same manner as " Suppression of the 
Menses," of which we have already spoken. (See that 
chapter.) The second, requires much the same manage- 
ment as directed for " Excessive Menstruation," which it 
is not necessary to repeat. 

The variety of affections which show themselves at the 



HYGIENE FOR WOMEN AT THE CHANGE OF LIFE. 131 

period we are now considering, require no peculiarity of 
treatment, though the loss of the menses and tendency to 
plethora must always be kept in view. Notwithstanding 
the hysterical, and other symptoms, are sometimes severe ; 
yet, they very soon disappear when the system becomes 
accustomed to the change of the circulating fluid, and it 
becomes more equally distributed over the other parts of 
the system. The following hygienic rules from the emi- 
nent French physician, before several times named in this 
work, will be found to embrace important directions for 
the management of the female at this epoch of her life. 

HYGIENIC RULES RELATIVE TO THE CHANGE OF LIFE. 

This great revolution, this remarkable epoch of life, 
which most commonly happens between the age of forty 
and fifty years ; but which is subordinate to the influences 
of climate, constitution and mode of life, to the social posi- 
tion and the healthful or morbid condition of the patient, 
requires such cares and precautions, of a hygienic nature, 
as may serve, as far as possible to prevent the evils to which 
women are then known to be liable. 

The first counsel they ought to receive is, an advice to 
reject all sorts of drugs and preparations, to which are 
attached such titles as " health pills," " elixir of long life," 
or " elixir of propriety "; and all the receipts that are 
loudly proclaimed by ignorance, puffed by charlatanism 
and old-womanism, accredited by the attractions of a 
vogue, and by millions of so-called miraculous cures : 
the approach of the critical period less, perhaps, than any 
other epoch, admits cf any infractions as to regimen, dress, 
bodily exercise, sleep and watching, the various excretions 
and, also, the affections, and passions of the soul. The 
diet, which ought not to be too nutritious, may be composed 
of white meats,, veal, chickens, fresh- water fish, vegetables, 
such as succory, spinach, acidulous fruits, cooked, and 
raw fruits very ripe. Such a person should reject all 
spiced dishes, ragouts, black and salted meats, coffee, tea, 
spiritous liquors, and, in fine, all stimulating and indigesti- 
ble food. Plethoric women, who are subject to copious 
menstrual discharges, should renounce late suppers, should 



132 HYGIENE FOR WOMEN AT THE CHANGE OF LIFE. 

.drink whey, cooling beverages, infusions with succory ; 
and acidulous mineral waters. All such women ought to 
make it a rule to take moderate exercise, with a vfew to 
distribute throughout the entire system, the excitability 
which is thus withdrawn from the reproductive system. 
Exercise taken in attending to household affairs, is so much 
the more favorable, as it is proportioned to the physical 
strength, and superadds, to the natural effects of toil, the 
internal satisfaction arising from the fulfilment of duty. 
Lastly, riding out in the country, where one may go to 
inhale the bracing air of morning ; the cares demanded 
for the proper culture of flowers ; short- excursions into 
pleasant regions of country, where the land is high and 
dry, especially in agreeable company, also constitute the 
kinds of exercise from which may be derived the happiest 
results. 

Women who have reached their critical period of life, 
should, with more than usual care, withdraw themselves 
from the influences of atmospherical vicisitudes, and 
especially from that of a cold, damp atmosphere,* which 
often gives rise to catarrhal discharges, leucorrheas, 
3tc. They would, also, do well to avoid, especially at 
those periods at which they are accustomed to menstruate — 
they would do well, we say, to avoid large assemblies, 
theatres, heated, close rooms, where only impure air can 
be breathed ; they ought, also, to eschew all low and damp 
situations, to give up the use of foot- warmers ; they ought 
not to sleep upon feather beds, nor on any bed that is too 
soft and too warm, for such are attended with the disad- 
vantage of promoting plethoric accumulations, and dispo- 
sing the system to attacks of uterine hemorrhage, of 
causing contispation of the bowels, and exciting the geni- 
tal organs, which should henceforth be kept; as far as pos- 
sible, in a state of inaction. Sleep, if prolonged beyond 
six or seven hours, long watchings, too much exercise of 
the mental faculties ; sensations, whether too acute or too 

* Among washer-women, and other females habitually exposed to 
damp cold, the cessation of the menses is, for the most part, distressing 
r*nd tempestuous: such women, likewise, are more liable than others to 
leucorrheal discharges, chronic inflammations, and cancerous affections 
of the womb. 



HYGIENE FOR WOMEN AT THE CHANGE OF LIFE. 133 

profound ; wrath, love of play, and all sorts of passionate 
sentiments, — these are especially hurtful to a woman about 
the close of her menstrual life. 

Love, a sentiment so gentle and so natural to the female, 
a passion which is, so to speak, the sole dominant passion 
of the sex., may, at the critical age, produce the greatest 
disturbance in the nervous system ; on this account, the 
use of venery could not be too moderate at this period of 
life, and should, in case of the appearance of any signs, 
be placed under complete interdict. Under such an event, 
it is the dictate of prudence to avoid all such circumstan- 
ces as might tend to awaken any erotic thoughts in the 
mind, and reanimate a sentiment that ought rather to be- 
come extinct, such as the spectacle of lascivious figures, 
the reading of passionate novels, and, in fine, every thing 
calculated to cause regret for charms that are lost, and 
enjoyments that are ended forever. 

Most women, as we have remarked, exaggerate to them- 
selves, the dangers of the critical age, representing the 
future in the most sombre hues ; they should be reassured 
upon this point, and disabused of the false idea they gene- 
rally form, that their menses are designed to purge the 
body of some virus or impure principle, and that the ces- 
sation of the flow is about to become the source of numer- 
ous disorders. They should be reminded, that when this 
short period is once past, their sex has a better chance of 
long life than ours. The persons who live with them ought 
to turn aside their sad thoughts, and avoid all occasions of 
strong feelings, and seek, indeed, to inspire them with none 
but complacent affections : assisted by the counsels of 
medicine, and of friendship combined, and arming them- 
selves with courage for the conflict, the sex may hope to 
spend many happy days, far beyond an age at which they 
suppose there is no further hope of happiness for them. 

How great soever may be the advantages of the hygienic 
measures we have just proposed, the health of many dif- 
ferent females, still demands the rigorous observation of 
many precautions, and the employment of certain thera- 
peutical agents, among which, we may mention venesection, 
issues, enemata, baths, and purgative medicines; bleed- 
ing is indicated on account of the plethora which gene- 



134 HYGIENE FOR WOMEN AT THE CHANGE OF LIFE. 

rally succeeds the final cessation of the menses. Re- 
course should be had to it at an early period, and it should 
be repeated from time to time, and at intervals, greater or 
less, according to circumstances. Bleeding at the arm is 
always preferable, because it should be rather derivative 
than spoliative. Bleeding-in the foot ought to be rejected 
in these cases ; as well, likewise, as the application of 
leeches to the vulva and thighs. This lisst method of ab- 
stracting blood is objectionable, as tending to increase the 
local irritation and plethora, which it is so desirable to 
remove. However, there are cases, very rare ones to be 
sure, in which leeches may be advantageously applied to the 
hypogaster, and even to the vulva; such are the cases 
when the lower belly and the pelvic viscera are affected 
with acute pain, that venesection at the arm, even when 
several times repeated, has been found incapable of alle- 
viating. 

Constipation ought to be combatted by the use of injec- 
tions, sweetened with honey, or prepared with the addition 
of a teaspoonful of olive oil. Suppositories of beurre de 
cacao, the use of the plunge bath and of gentle laxatives, 
such as Seidlitz water, ptisans with prunes, tamarind whey, 
veal broth or vegetable broth, infusions of wild succory, 
and other drinks of the same sort, containing a weak so- 
lution of sulphate of soda, are proceedings to be instituted 
with andvantage to the patient. Drastic cathartics, espe- 
cially aloetic purgatives, ought always to be rejected, for 
they excite the viscera of the pelvis, especially the womb 
and the rectum, too much, accumulating in that direction 
congestions that frequently lead to attacks of menorrhagia 
and obstinate hemorrhoidal disorders. For similar rea- 
sons, we ought to abstain from purgative injections invari- 
ably, as well as from hip-baths, nor have recourse to com- 
mon injections without care in the employment of them, 
and only in cases of absolute necessity. 

Those women, who, in early life may have been sub- 
ject to swellings of the joints, or of the lymphatic gangli- 
ons, to ophthalmias, and to cutaneous eruptions ; and 
"those, lastly, who happen to labor under chronic, mucous, 
or parenchymatous inflammation, etc., will act prudently 
by establishing some point of derivation upon the skin by an 



LEUCORRHE A— NATURE. 135 • 

issue, and especially by a blister. Petit Radel has justly 
remarked, that the last named exutory is preferable to the 
former kind, because it acts upon a more extended sur- 
face, and the irritation produced by it may be easily in- 
creased or diminished. Let us close by remarking, that 
the cessation of the menses, which is a physiological phe- 
nomena, as natural as the first appearance, would almost 
always terminate well, were it not that former excess, 
careless dieting, and a treatment not unfrequently foreign 
to the principles of the art, intervene and oppose its pro- 
gress. We cannot, therefore, too loudly proclaim to the 
sex, that infractions of the laws of hygiene may lead them 
into the arms of death, at a period which would have been 
for them, the commencement of a more tranquil life, and 
an existence exposed to much fewer dangers. 



CHAPTER VIII. 

LEUCORRHCEA NATURE VARIETIES — SYMPTOMS CAUSES, 

AND TREATMENT. 

. The term leucorrhcea is derived from two Greek words, 
signifying white flow, which is synonymous with flu or albas 
and the English word whites, and is applied to designate 
the discharge of a white or colorless fluid from the vagina, 
unconnected with structural disorganization of the parts. 
Though the discharged fluid may vary in color, consist- 
ency and quantity, depending upon the stage of the dis- 
ease ; — in color, from a white, to that of a green, brown, or 
slightly redish tinge ; — in consistence, from that of limpid 
water merely, to that of a ropy substance, mixed with a 
thinner liquid ; — in quantity, from a slight increase of the 
natural secretion, to several ounces in the tw T enty-four 
hours. 

This discharge originates in the minute blood-vessels 
which line the cavity of the vagina and uterus, probably 
often the same as those engaged in secreting the menses ; 
though upon this point authors are not positive. 

These vessels, are minute and countless in number. 



136 LEUC0RRHE A— NATURE. 

forming a complete membrane, similar in structure to the 
mucous membrane of the mouth, nose, and throat ; they 
both secrete a mucus very similar in consistence and ap- 
pearance, and that of the former like unto that of the lat- 
ter, under various states of disease, may become gluey or 
puriform and tinged with blood. These mucous disorders 
have a general resemblance to each other, whatever be 
their seats or sources. 

Leucorrhea is so very common, that it is, perhaps, as 
rare to meet with a woman who has never had some form 
of it, as to find one who never in her life had a cold in the 
head or the slightest increase of discharge from the nose. 
(Meigs.) It may attack females of all ages, a more 
chronic form occurring in advanced life ; it is most com- 
mon, however, during the period comprised between the 
ages of fifteen and forty-five, rarely appearing after that 
time, unless it be symptomatic of organic disease of the 
uterus, as cancer, etc. Children and even infants are 
subject to acute attacks, with more or less local inflam- 
mation ; here, the mucous membrane of the vagina only 
shares in the general susceptibility of this class of organs 
at this period of life, in which also, the intestinal surface, 
that of the lungs, throat and nostrils, participate, being 
more active than at any other stage of existence, and 
the seats of maladies unfrequent or unknown at a later age. 
Leucorrhea, occurring in infancy is generally a catarrh 
of the vagina, and often sympathetic of intestinal irritation. 

This disease is observed in women of every tempera- 
ment, according to the peculiar cause: In the lymphatic, 
in whom, from deficient power the uterus is unequal to the 
secretion of the florid menses, or from constitutional caus- 
es, the vessels of the mucous membrane lining the womb 
are in a state of unusual activity ; — in the melancholic, 
where mental depression aids in the aggravation of what 
originally might have been a slight congestion, their fears 
being actually alive to any disorder of these parts ; and in 
the plethoric and robust, in whom the circulation, rapid 
and energtic, throughout the whole system, is peculiarly 
so in the sexual organs during their functional life. 
Though it is far oftener observed in the lymphatic temper- 
ament, than in the sanguine, or in those of a debilitated 



LEUCORRHEA NATURE. 137 

constitution, than in those who have an active circulation. 
In the higher orders of society, where from luxurious ex- 
citements, the nervous system is so much, and the muscu- 
lar so little exterted, this malady is particularly common. 
There are few disorders of the general health unaccompa- 
nied by irregularity of the vaginal secretion ; and any 
thing that tends to over-excite or debilitate the uterine 
system will produce it. 

In regard to the seat of this disease, it is known that 
pregnant women, in whom the orifice of the uterus is 
closed, are subject to it, proving that in these instances, it 
is exclusively vaginal. On the other hand we are equally 
certain that irritating causes may give rise to unhealthy 
secretion from the lining membrane of the uterus — also, 
when irritated by structural disorder, the matter discharg- 
ed is sometimes not to be distinguished from that of common 
leucorrhea. It is even probable that the Fallopian tubes 
do sometimes afford a part, and even a considerable por- 
tion of the matter discharged. (Meigs.) In the majority 
of cases, however, it is believed that the vagina is the seat 
of the discharge. (Ferguson.) 

The most common circumstances, according to Churchill, 
under which uterine leucorrhea occurs, are the following : 

1.. In young females of delicate constitution, there may 
be a secretion of whites at one, two, or three of the month- 
ly periods preceding the appearance of the menses, and 
vicarious of them. By the discovery that the uterine 
system is already in action, though giving rise to a morbid 
discharge, the treatment must be modified accordingly. 
(See " Suppression of the Menses. ") 

2. In suppressed menstruation, the subsequent monthly 
periods may be marked by a white discharge, nearly the 
same in quantity, and continuing as long as the natural 
secretion. 

3. The intervals of menstruation may be occupied by 
leucorrhea ; in these cases the discharge increases just 
before the appearance of the menses, and re-appears in in- 
creased quantity afterwards ; ultimately the leucorrhea 
may entirely supersede the menses. 

4. Excessive menstruation is sometimes caused, and 
often accompanied bv the white discharge, which increases 

G* 



138 LEUCORRHEA SYMPTOMS. 

just before and after the menstrual periods, and may oa 
cupy the intervals. 

5. At the period of " decline of the menses," the few 
last returns may be marked by the occurrence of whites, 
instead of the proper menstrual discharge. 

6. In chlorotic patients, leucorrhea may be vicarious of 
the menses. 

7. After abortion a white discharge may be secreted, 
either constantly, or occasionally for some months, which 
predisposes to successive abortions. 

8. After child-bearing, when the lochia has disappeared, 
the white discharge may appear and continue for a month 
or two, or longer, till superseded by the appearance of the 
menses. 

Vaginal leucorrhea may be present, or complicated with 
any of the foregoing cases, though perhaps the uterine 
disorder predominates, modifying all the symptoms. No 
one or even all of these cases, are near as frequent as a 
chronic form of simple vaginal leucorrhea, as this is one 
of the most common diseases to which females are subject ; 
few, as we have remarked, escaping an attack of it at 
one time or other of their lives. 

The forms of leucorrhea are either acute or chronic. 

Symptoms. — Sometimes from its brevity and slight devel- 
opment the acute state may have passed unnoticed , 
though, there is generally a greater or less degree of con- 
stitutional excitement, or local suffering present. The 
pulse is quickened, the skin is hotter than natural, there 
is some thirst, and the patient is liable to hysteric par- 
oxysms. There is a sense of heat and pain in the vagina, 
with slight swelling and tenderness ; and at first a thin 
exudation, like that in common catarrhal inflammation of 
the mucous membrane of the nose ; it then becomes thick- 
er, and afterwards thin pus, with the formation of which 
the pain and swelling abate. The irritation may be com- 
municated to the bladder, giving rise to retention of urine. 
If the attack be violent there will be weight and pain in 
the lower part of the abdomen, extending down the thighs. 

In the chronic form there is a variation in the symp- 
toms, corresponding with the quantity and quality of the 
discharge. In the slighter and more recent cases, but 



LEUCORRHEA SYMPTOMS. 139 

little distress is experienced ; there is a degree of languor, 
occasional weakness in the back and loins, headache with 
a paler complexion than natural, and an unusual degree of 
moisture about the external parts of generation. But 
when the discharge increases, the symptoms become more 
severe. There is constant pain in the back and loins, 
signs of debility, and dyspepsia, with nervous excitability. 
The discharge of matter is generally imperceptible, and 
continuous, often, however, flowing in slight gushes, or 
mixed with masses of ropy mucus. The following pas- 
sage from Dr. Vigarous, gives a clear and succinct ac- 
count of the symptoms and progress of this disease, to its 
termination : 

At first, the patient perceives a discharge of mild mat- 
ter, almost white, which moistens the vagina and escapes 
drop by drop. She experiences no inconvenience, no pain, 
nor any morbid sensation, (unless there be weight in the 
loins with colic pains). Hence, women, prevented by an 
excess of modesty, take no precautions in this stage, and 
neglect a disease, which, at this period, is of easy cure, 
but which soon becomes obstinate. Women pass several 
years in this way before the danger is exhibited by severe 
symptoms. After the lapse of some time, more or less, 
and after all precautions and all remedies have been 
neglected, the urine becomes thick, and, according to 
Hyppocrates, similar to that of mare's, jumentosa. The 
pulse is vermicular ; the discharge becomes so abundant 
as to soak through the napkins which she employs, (it 
seems to attract to itself the sources of all the other excre- 
tions) ; the matter becomes, successively, greenish, yel- 
low, black, and similar to washings of flesh ; it becomes 
acrid, and occasions pain, excoriations, ulcers of the womb; 
the woman takes an aversion to coitus ; the face becomes 
pale, bloated ; the eyes swell, and are surrounded by a 
yellow circle, as in dropsical people, they loose their lustre 
and become heavy and dull ; the appetite is lost, (or de- 
praved with nauseous eructation from acidity of the sto- 
mach); grief and sorrow take possession of the patient ; 
(there is almost constant pain in the spine and loins, the 
hips and stomach ;) the senses are weakened, particularly 
vision ; sighing and lassitude, upon the slightest exertion, 



140 • LEUCORRHEA CAUSES. 

indicate the greatest debility. Gradually the smell of tho 
matter becomes insupportable ; (there is obstinate consti- 
pation of the bowels, with nausea and acid vomiting;) the 
menses flow irregularly, often are suppressed ; and hectic 
seizing the patient, soon drags her to the grave. {Tom. I., 
page 235 — translated by Meigs.) This may be thought a 
highiy wrought picture, but it is the sad termination of 
occasional cases, whose cure has been entirely neglected. 
It shows the importance of timely attention to the treat- 
ment of a disease which may be so calamitous. 

Upon examination, it is sometimes found, though rarely, 
that there is slight enlargement of the body of the uterus, 
with some tenderness in the acute form ; also, the mouth 
of the uterus is found swollen and tender, and rather more 
open than in the healthy state. Upon using the speculum, 
is discovered the mucous membrane of the neck, pale, 
slightly rose colored, deep red, or spotted ; these red points 
are probably the inflamed orifices of muciparous glands, 
which are numerous in the canal of the neck, and are 
supposed, in a peculiar form of this disease, to give rise 
to an albuminous fluid, resembling the white of eggs. 
This sort of discharge is to be met with in women who 
do not bear children ; the quantity is small and seems to 
have but one inconvenience, and that is, of rendering the 
woman barren. All means of cure have been employed in 
vain, in some obstinate cases of this form of the affection. 

The Fallopian tubes are sometimes discovered to have 
undergone a change : they are found very much enlarged, 
and filled with puriform mucus and blood. 

In a great proportion of cases, however, upon exami- 
nation with the speculum, though the individuals have made 
loud complaint of the troublesomeness of the discharge, no 
inflammation or ulcer has been discovered, — nothing but 
an abundant, then mucus, bathing the vaginal surfaces. 

The causes of leucorrhea are very various and nume- 
rous ; they may all, however, be included under two classes, 
the local and constitutional ; the latter of which are by far 
the most common and important. 

The local causes are, cold, violence from rape or instru- 
mental delivery, excessive coition, abortion,' inflammation 
spreading internally from the vulva, the use of quack 



LEUCORRHEA CAUSES. 141 

emmenagogue medicines, stimulating injections, the irri- 
tation arising from worms in the rectum, or a pessary al- 
lowed to remain too long in the vagina, displacements, etc. 

Women who too freely indulge in the gratifications of 
love, who, from their necessities, or calling, are exposed 
to the ahuse of vener-y ; and especially those who indulge 
in solitary or selfish abuse of this enjoyment, are always 
obnoxious to leucorrhea. " Nature, for the wisest purpo- 
ses, has implanted in the sexes the passion of love ; it pre- 
sides like a guardian angel over every sentiment that is 
pure and holy in our natures; it warms the heart and 
kindles the affections with a flame of vestal purity ; but 
let the reader beware of the premature excitement of a 
passion that was only designed by the Creator to ensure 
the great end of our existence, viz : the perpetuation of 
the species. 

" What a proof of the entire purity of purpose on the 
part of nature, when unsullied by art, is the affection of 
a mother for her child ! Think of the strength and dura- 
tion of that passion — compare it with an impure emotion, 
and then ask if we should not blush to lose sight of an 
impulse so lovely, for the indulgence of a base and selfish 
gratification." 

In treating of "deranged menstruation," we had occa- 
sion to refer to the evils of the miserable quack composi- 
tions, heralded by their unprincipled inventors as specifics 
for menstrual derangements. The infirmity which We are 
now considering, is often closely complicated with the other 
and produced by the same causes, and we often have to 
deplore the alarming mischief produced by the futile ef- 
forts of the ignorant pretender, to cure this disease by 
powerfully drugging the system with physic. 

Dr. 1 Mei^s mentions a considerable number of cases of 
leucorrhea that came under his observation, in which the 
disease was produced by the irritation of pessaries, (in- 
struments to support the uterus — see prolapsus of that 
organ) which had been allowed to remain in the vagina. 
Of course, all attempts to cure must fail till such causes 
be removed. 

The constitutional causes of leucorrhea, we have re- 
marked, are both numerous and important. Most of those 



142 LEUCORRHEA CAUSES. 

errors in diet, regimen, physical education, etc., so often 
referred to in our remarks upon menstruation and its de- 
rangements, act here with equal force. So that all we 
have there said upon the operation of these great agents 
in forming the human constitution, is equally applicable 
in relation to this disease. The following circumstances 
are found to act powerfully in the production of leucor- 
rhea : — ' 

1. Original constitution or temperament : there is a de- 
ficiency of secretive energy, as exhibited in those cases 
when leucorrhea is vicarious of, or introductory to, the 
menses. This condition exists mostly in those of a scrofu- 
lous habit, either hereditary or acquired, and the lympha- 
tic tempei ament ; they are generally characterized by a 
relaxed fibre, fair skin, and light hair. 

2. Location, atmosphere, and occupation: thus, women 
who reside in a damp and cold climate, where there is a 
humid, impure air ; also, those of sedentary and luxurious 
habits, who live in indolence, in large cities, are almost 
sure to have this complaint. 

3. Habits of life, and the quality, and quantity of nour- 
ishment : they affect all constitutions and temperaments. 
Those who indulge much in bed, who keep late hours, 
who over stimulate, who indulge in emotions and passions 
of the mind, who drink immoderately of thin unnourish- 
ing drinks, as tea and coffee, who use the warm bath, or 
" foot-stove" to excess, rarely escape it. 

4. Habits in regard to cleanliness ; the -neglect of this 
physical virtue, will be almost sure to produce it, even in 
those who are not otherwise disposed to the disease. 

Women in the lower walks of life, especially in cities, 
are more exposed to many of the predisposing causes of 
"leucorrhea, and consequently are more obnoxious to the 
disease. It is pretty sure to follow nervous and hysterical 
affections, especially if there be great irritability of tem- 
per. Those who have suffered from frequent and difficult 
labors and over suckling, those who have relaxation of the 
system generally, and of the uterine particularly ; who 
have become debilitated from menorrhagia, diarrhea, he- 
morrhoids, or who labor under irregularity or suppression 
of the menses, are ever prone to this complaint. 



LETTCOREHEA CAUSES. 143 

In' fact, the constitutional causes of this disorder are so 
numerous, that the majority of authors we have consulted 
upon the subject of leucorrhea, make it a constitutional 
disease. It has been thought by some to be hereditary. 
Some ladies are not constantly afflicted with it, and only 
have a discharge when their systems are excited ; as by 
fever, anger, alarm, or joy ; others,, upon taking a glass 
of wine, eating highly seasoned victuals ; others, again, 
when their stomachs are acid, or otherwise irritated, will ■ 
have this discharge more abundantly ; very many are only 
sensible of its existence just before the menses are about 
to appear, or immediately after they have ceased. Most 
women, who are subject to leucorrhea, will have an in- 
creased discharge when pregnant; while some will have 
it at no other time ; and all, perhaps, will have it more 
abundant after too great venereal indulgence. (Dewees.) 

In speaking of the causes of this disease, an eminent 
French physician remarks: "The mode of life to which 
the social condition condemns women in large cities, delivers 
them over, so to speak,, defenceless against the numerous 
causes of the chronic inflammation of the utero- vaginal mu- 
cous membrane. Thus, in populous cities, idleness, effemi- 
nacy, or sedentary life, the constant contact of the sexes, 
and the frequenting of places where every thing inspires 
pleasure; prolonged watching,- excessive dancing, frivo- 
lous occupation, and the study of the arts that give too great 
activity to the imagination ; erotic reading ; the perni- 
cious establishment of an artificial puberty ; the prema- 
ture shock of the genital system ; the concentration of the 
sentiments and thought? on objects which keep the genital 
system in a slate of permanent excitation ; finally, a num- 
ber of vicious habits, and excesses of all kinds, which, by 
introducing modifications more or le*s profound into the 
general constitution, re-act more particularly upon the 
sensibility of the womb, which, in the fern a e, is not only 
the organ most apt to lend itself to the fhwionary move- 
ments, but, likewise, the centre towards v^hicli all the 
morbific actions seem principally to tend." 

We have before adverted to the injurious effect of an 
habitual indulgence in the excessive use of tea and coffee ; 
and all physicians can bear witness to the pernicious influ- 



1 44 LETJCORRHEA C AUSES, 

ence of these articles, of which our country women are 
so fond, and which they so generally use in excess. We 
are well satisfied that they exhaust the nervous system, 
weaken the stomach and derange digestion. In before ad. 
•verting to the warm bath as a debilitating cause, we shall be 
understood as referring only to its excessive use in the 
higher classes of society, as they are termed ; for in the 
lower, it is not abused, since, alas ! it is seldom sufficiently 
used. When properly applied it is a powerful means of 
preventing disease, but may be, if perverted, an equally 
efficacious agent in its production. Over five minutes 
indulgence in a warm bath at the temperature commonly 
used, is likely to be followed by exhaustion ; it should be 
immediately followed by the shower bath, and friction with 
a rough towel — which produce an agreeable reaction and 
establish a healthful circulation in the skin. 

The application of cold from dampening the feet, sitting 
on the damp ground, etc., is a very different thing from, 
its application by the shower bath, and is productive of 
the worst consequences. Also excessive warmth, as too 
close confinement in hot rooms, too much clothing, sleep- 
ing too warm on feather beds, etc., by causing exhaustion, 
will produce the same result. 

" The constant drugging of unprincipled pretenders, 
many of whom, we grieve to say, are provided with their 
legal warrants under our degrading system of medical 
education, is equally productive of the disease. The tone 
of the body is impaired, by the incessant irritation of the 
bowels with every variety of qauck pills and potions, un- 
til the whole vascular system becomes exhausted, and the 
blood-vessels of the uterus open their mouths, as it were, 
like dead creatures, and suffer the blood first to escape 
in large quantities, constituting excessive menstruatio n ; 
then, as we know by observation, they take on that pecu- 
liar action, productive of the leucorrheal secretion. " 

The duration of leucorrhea is variable. Those cases 
connected with the menstrual function are generally the 
most prolonged. The question has arisen as to whether 
the discharge of this disease, (not venereal) may not give 
rise to a gonorrheal discharge, or sores in the male. There 
have boon sn^miri.t? eases m confirmation of such a fact, 



LEUCORRHEA TREATMENT. 145 

but Dr. John Hunter and other authors, are of opinion that 
it never takes place ; though when very acrid it is often 
observed to give rise to a temporary mucous discharge. 

In the treatment it is necessary to distinguish the simple 
leucorrheal discharge from that which is caused by local 
disease, as polypus, prolapsus, ulcerations and excressen- 
ces. (See the symptoms of those diseases wider their pro- 
per chapters. 

Treatment. — This of course must have reference to 
the cause which produced the disease, to the state of the 
constitution, and that of the uterus and vagina. It is con- 
solatory to know that it is generally successful, if the 
proper remedies are applied in season and persevered in. 

The parts must be regularly washed in warm water 
three or four times a day — and if the patient be plethoric, 
or if in the acute form and plethora be not present, local 
depletion* is required ; this may be done by cupping tho 
loins, or applying leeches to the vulva. During this stage, 
which is short, the patient should be confined to the hori- 
zontal position, and be purged with saline cathartics ; tho 
diet should be very spare and all possible causes of ex- 
citement avoided. Vaginal injections of warm water, and 
occasionally a hip bath are powerful adjuncts in abating 
the inflammation. If by these means, or a neglect oi 
them, the disease is not cured, it very soon assumes the 
chronic form, which is vastly more common than the 
other. 

Before speaking of the medication necessary in the 
chronic form, we shall • give directions concerning diet, 
regimen, etc., which are quite as important. As we are 
writing partly for the instruction o'f females, it will have 
been observed, that in our descriptions we de not always 
follow the usual systematic order found in medical books. 

We have endeavored to show that this disease has its 
origin in deep-seated causes — no less than an abuse of the 
great laws of nature. The intelligent physician well 
understands the absurdity, by the administration of medi- 
cine alone, of attempting to change the long continued and 

*Dr. Dewees recommends that a strict antiphlogistic plan be con- 
stantly pursued during the cure of either stage of this "omplamt, till we 
are assured the discharge is maintained by habit." 



! 45 LEITCORRHEA TREATMENT. 

unhealthy action of parts, that have not for years performed 
their natural functions, while the cause by which it was 
produced remains still in action. It is evident that there 
is no alternative but for the female, perseveringly to re- 
trace and reform her errors befor there can be any hopes 
of a restoration to health. 

The remarks already made upon hygiene in Part III., 
are here particularly applicable. If the female would 
escape, or be rid of this affection, " the mind must be kept 
pure, and free from improper associations. Such is the 
wonderful influence upon the uterine system, that, as we 
have shown, any of the more intense emotions will pro- 
duce it, if the patient be predisposed from debility to the 
disease. 

" Far more certain in its influence, because, alas ! 
much more common, is that state of prurient excitement of 
the imagination, so often produced by the wretched and 
demoralizing flood of " cheap literature" as it is called by 
its unprincipled publishers. Were the statute against 
obscene publications and prints, properly enforced, our 
families would be rid of these loathsome and filthy produc- 
tions, and society freed from a curse that is sapping it in 
the most vital part, viz : the moral purity of its daughters 
and mothers. 

In leucorrheal discharge of the chronic form we must 
first be assured of the absence of polypus, excr essences, etc. 
in the vagina and uterus ; next we must ascertain that the 
discharge is not a symptom of oppressed circulation, or of 
disease in the rectum, or other neighboring parts. . If, 
upon examination, any of these diseases be found to exist 
they must be treated as elsewhere directed. When it is 
made out that the malady is dependent on a local state, 
combined with disorder of the general health, the treat- 
ment for the chronic form will be safely applied. In a 
great majority of cases hysteria, in some of its- various 
forms will be found to accompany the discharge. In some, 
there is inordinate nervous sensibility, in others, torpor 
and inactivity ; while again with general debility, there 
is much nervous irritation in the uterine system, constant 
pruritus, or aching which is more intolerable than pain 
itself In all of these grades of the disease, the uterus 



LEUCORRHEA TREATMENT. 147 

and vagina do not fail to draw into their sympathies the 
digestive organs. 

Strict attention, therefore, must be given to diet, exer- 
cise, and mode of life. The food should be devoid of all 
excitement, simply nourishing without stimulating the 
stomach; pure air, and absence from those habits of late 
hours, entailed by a city life are essential to a speedy 
cure ; and with these, all that regimen so well known as 
the dyspeptic should be resorted to. 

When proper attention, then, has been given to the re- 
duction of the pulse, and evacuation of the bowels, as 
mentioned under the acute form, a blister may be applied 
to the sacrum and repeated if necessary ; we must then 
proceed to exhibit some of those medicines which act upon 
the utero- vaginal membrane through the general system. 
The best are balsam copaiba, cantharides, cubebs, and the 
various turpentines. The copaiba may be given in in- 
creased doses, commencing with fifteen drops three times 
a day, or if the stomach be delicate, it may be made up 
into pills. The tincture of cantharides, according to De- 
wees, is very efficacious ; he says, " of this I direct thirty 
drops every morning, noon and evening, in a little sugar 
and water, increasing the dose every third day, five drops 
at a time, until strangury, (difficulty of passing the urine) 
is produced, unless the disease be arrested, which is not 
unfrequently the case, before this symptom appears." 
The patient should desist from the use of the medicine as 
soon as she feels the approach of strangury, and if neces- 
sary resume it when all uneasiness has disappeared. If 
the strangury be severe, free use should be made of flax- 
seed tea, gum Arabic or barley water — and the patient 
may take, upon going to bed, twenty five drops of lauda- 
num. The cubebs may be used in doses of from ten to 
thirty grains every six hours — if not speedily useful it 
should be discontinued'. Any of the turpentines may be 
given in doses of from a scruple to a drachm, in pills, or 
in mucilage of gum Arabic. Extreme cleanliness must 
be observed, or little good will be derived from the best 
plan of treatment. 

As soon as a change is observed in the discharge, by 
its becoming thinner and more copious, astringent injec- 



148 LEUCORRHEA TREATMENT. 

tions may be employed with the happiest results ; they 
should only be used as long as no tenderness, or sense of 
weight in the pelvis be produced by them. In the milder 
cases a decoction of Peruvian, or oak bark, or catechu 
may be used ; but in general the best astringent injections 
are the sulphate of zinc, in proportion of five or six grains 
to the ounce of water : or, from twenty to thirty grains of 
the sulphate of copper to eight ounces of water ; alum 
may be used (20 grains to 6 ounces of water.) A so- 
lution of nitrate of silver (4 grains to the ounce of 
water,) is very useful. Vaginal injections of soap and 
water should be used previous to any one of these, which 
may be employed three times a day. 

When the leucorrhea is accompanied with sensibility, 
. pruritus, etc., of the vagina and uterus, anodyne injec- 
tions are indicated: as twenty-five or thirty drops of 
laudanum in mucilage or water, poppy decoction, etc. 

When the leucorrheal discharge is profuse, and becomes 
yellowish, or pus-like, . astringent medicines internally, 
synchronous with their local application, will be found 
very useful ; the decoction of logwood, gum kino, or 
catechu, etc., are applicable. A very absurd idea is 
occasionally entertained, that this discharge is a healthful 
evacuation, and ought not to be interfered with. We need 
not say that it is of the greatest injury to the constitution, 
and should be cured as soon as possible without a too sud- 
den suppression. The following formula will be found 
a very useful astringent : Take of gum kino one part, 
Canadian turpentine four parts, as much of the powder of 
tormentilla as may be necessary to form a mass ; divide 
the same into pills of five grains each, and take from three 
to half a dozen of them night and morning. At this stage 
of the disease, the ergot of rye has been highly recom- 
mended in five grain doses, three times a day. At this 
period, as well as during the whole course of the disease, 
the bowels must be kept open by a laxative diet, and the 
occasional use of cathartics.* Electro-magnetism may 
be tried along with the other remedies. 

* In obstinate cases, much reliance has been placed by some physi 
cians, upon revulsive determination towards* the intestinal mucous- mem- 
brane by the use of purgatives ; rhubarb, in small doses is the best, as it 
is at the same time purgative, tonic and astringent. 



LEUCORRHEA TREATMENT. 149 

In addition to the local and constitutional treatment 
already noticed, where there is much debility, as there 
generally is, the class of remedies known as tonics are not 
to be dispensed with. The vegetable ones, such as bark, 
gentian, quassia, cascarilla, etc., may be used ; but the 
preparations of iron and iodine are most to be relied on. 
Of the former, the carbonate, or citrate may be adminis- 
tered in the usual doses ; but, perhaps, the best form is 
the sulphate, combined as follows: sul. iron, one scruple, 
balsam copaiba and liquorice powder, of each sufficient to 
form a mass of proper consistency, which is to be divided 
into forty pills, of which three or four may be taken three 
times a day. The use of iodine has been highly praised, 
and in those cases of leucorrhea which are so common in 
scrofulous constitutions, this remedy is preferable to all 
others. The compound tincture may be given in doses of 
from ten to twenty drops, three times a day, or the syrup 
of iodine, or of the iodide of iron, in doses of two tea spoons- 
ful three or four times a day, in some appropriate infusion. 

In those cases of leucorrhea characterized by an albu- 
minous discharge, and dependent on an inflamed and sensi- 
tive condition of the mouth and neck of the uterus, the 
means of cure are, rest, moderate use of leeches to the 
mouth itself, purging and injections of warm water and 
soap and mucilages, aided by the judicious employment 
of blue mass and anodyne enemata. 

Those cases which are complicated with menstruation, 
must be treated with reference to that discharge. Coni- 
um, hyosciamus, or opium may be given if there be much, 
local or general irritation. Cleanliness, as before remark- 
ed, is of the utmost importance ; the external parts should 
be washed with tepid water, or milk and water, two or 
three times a day and carefully dried. When the disease 
is on the decline, benefit will be derived from sponging the 
back, loins, and lower part of the abdomen with tepid or 
cold salt . water. Sea bathing, with proper precautions, 
may be allowed ; and benefit will probably be obtained from 
a residence at, and the use of waters of mineral springs. 

The state of the stomach and bowoly should be particu- 
larly attended to — frequent but gentle purging is generally 



150 CHLOROSIS SYMPTOMS. 

useful. If there be any excoriation, the use of a sugar 
of lead lotion, or black wash will probably remove it. 

Leucorrhea dependent on prolapsus of the uterus often 
requires for its cure the use of the pessary — which will 
be explained when we come to treat of that subject. 



CHAPTER IX. 

CHLOROSIS NATURE SYMPTOMS CAUSES AND TREATMENT. 

The term chlorosis is derived from a Greek word, 
signifying green, — called " green sickness," from the pe- 
culiar pale or greenish complexion of those afflicted with 
it. It is. a disorder of the general health, and arises as 
the consequence of retention of the menses, excessive 
menstruation, long continued leucorrhea, and other de- 
pressing and exhausting diseases, bad nutrition, etc. The 
organs of digestion and assimilation are often the seat of 
the disease, which occasionally appears in the male as 
well as the female. The blood, in this affection, has often 
been found very much changed in its natural constituents. 

Symptoms. — No disease inspires more tender interest, 
or more touching compassion, than the state of paleness, 
suffering and languor, observed in a young chlorotic girl ; 
like some delicate plant, deprived of the beneficent rays of 
the sun, she is a flower which withers and droops away, 
even before its blossoming. 

The approach of chlorosis is marked by a state of habit- 
ual inertia and melancholy ; the patient becomes • sombre 
and taciturn, weeps without cause, and sighs involuntarily; 
the face becomes bloated ; the expression is, as it were, 
veiled ; the eyes sad and languishing ; the eyelids, which 
are swollen, especially in the morning, are encircled by 
a blackish areola, strongly contrasting with the pearl-white 
color of the schlorotic coat and the pallor of the lips ; the 
skin, particularly of the extremities, is dry and cool ; the 
pulse frequent, rather large and less easily compressed ; 
the respiration is difficult ; digestion is deranged ; the 
alvine dejections become white, hard, and sometimes fluid ; 



CHLOROSIS — SYMPTOMS . 151 

palpitations and fits of yawning make their appearance, 
while debility, lassitude, a desire for sleep, or rather for 
repose, as well as the whole collection of symptoms aug- 
ment from day to day. The patient feels frequent incli- 
nation to make deep and very strong inspirations, a symp- 
tom which is excited and increased by walking, by ascend- 
ing, and, finally, by any mental emotion. The impulse of 
the heart is generally stronger than natural ; and the ca- 
rotid arteries, which beat with great force, are the seat of 
certain abnormal sounds. Blood drawn from the venous 
system and from leech bites, is pale and aqueous ; the clot 
is soft and diffluent ; the animal heat is diminished ; the lips, 
nose, hands, and all the organs situated at a distance from 
the centre of circulation, are cold and almost icy ; the 
general cellular tissue becomes the seat of a serous tur- 
gescence which is especially observable about the eyelids 
and face. The inferior extremeties, particularly the ankles, 
become edematous, a condition which is more marked to- 
wards evening, and which differs from that of common 
dropsy, in not retaining the impression of the fingers. 

As this disease progresses, the functions of the stomach 
are more and more deranged ; the strangest and most de- 
praved tastes manifest themselves ; the patient prefers the 
most sapid substances, such as salt, vinegar, green fruits ; 
they often seek, with avidity, indigestible substances, and 
such as are In no way nutritive, as charcoal, plaster, earth, 
ashes, spiders, flies, and other equally disgusting insects. 
The appetite gradually diminishes, until complete anorexia 
is established ; at other times, on the contrary, it is in- 
creased beyond measure, while the ingestion of food is 
followed by a sensation of weight at the epigastrium, by 
nausea, and sometimes by vomiting. The tongue is gene- 
rally large and covered with a mucous coat ; acid regur- 
gitations, and frequent nausea occur, especially in the 
morning; a feeling of heat and weight in the epigastric 
region, and sometimes nervous pains in the course of ihe 
esophagus, and extending through to the shoulders, make 
their appearance. Finally, the patient experiences alter- 
nations of constipation, and watery diarrhoea. The alvine 
dejections are white, while the urine, small in quantity, is 
\>ale and limpid, as in all the nervous affections. The 



152 chlorosis — causes. 

genital organs are commonly affected with abundant leu- 
corrheal discharge ; most generally there is a failure or 
suppression of the menses ; at other times, they persist 
and last longer than natural ; which gives rise to the most 
diverse nervous disorders, uterine colics, pains in the loins, 
great depression and stupidity. The patient now, more 
than ever, seeks solitude, sighs involuntarily, and weeps 
without cause ; she is tormented by sinister ideas ; her 
temper is capricious, odd and irascible ; for her, all thought 
of happiness is gone, and in her despair, she often speaks 
of suicide ; finally, the night, far from procuring repose, 
brings her only broken slumbers and frightful dreams. 

When the progress of the disease is not arrested, the 
symptoms become more and more agravated ; there is 
ringing in the ears, vertigo, partial loss of sight, tremors 
of the limbs, neuralgia of the teeth, neck and head, ana 
hysterical symptoms ; the skin assumes a greenish or 
earthy hue ; the abdomen is hard and tumid ; thirst arises, 
the dispncea, faintness and palpitations are increased ; diar- 
rhea, as well as hectie fever creep in ; daily exacerbations 
occur, and the emaciation makes rapid progress. Finally, 
general infiltration, extreme feebleness, invincible repug- 
nance to all kinds of exertion, alteration of the features, 
and a pale, violet color of the lips, forbode approaching 
death ; which comes at last, without shock and almost with- 
out pain, surprising the patient under a complete state of 
marasmus. 

We have compiled the foregoing symptoms of this dis- 
ease from M. Colombat, whose descriptions are always so 
accurate as to leave nothing important unincluded. We 
should state that the duration of chlorosis has no fixed 
limit, but that when properly treated, it commonly termi- 
nates by a return of health in from one to two months. 

The causes of chlorosis may be divided into the predis- 
posing and general. Among the former, may be ranked 
hereditary predisposition, rapid and premature growth, a . 
feeble, melancholic constitution ; a lymphatic, nervous, or 
scrofulous temperament; the privation of the physical 
enjoyments of love, or their abuse ; the state of widowhood ; 
onanism ; sudden and continued suppression of the men- 
ses, and their too great abundance \ frequent hermorrha- 



CHLOROSIS CAUSES. 153 ' 

ges ; depressing moral emotions, disappointments, grief, 
sadness, captivity, and the melancholy which accompa- 
nies unfortunate love, etc. 

The general causes, are living in low, damp, and cold 
situations, secluded from the solar rays, as in quarries, 
mines, dungeons, the cellars of weavers, in low work shops, 
in valleys of great depth, which are shaded by wood, and 
in the sombre, narrow, and badly ventilated streets of 
large cities. Periods of famine, continued use of heavy 
indigestible and decomposed food ; the indulgence in warm 
aqueous drinks, or in the excessive use of vinegar, of 
green fruit, and all crude articles ; excessive fatigue, and 
finally, the want of exercise, and a sedentary, easy, volup- 
tuous mode of life, are all causes of the nervous debility, 
which give rise to the derangement of the functions, con- 
stituting chlorosis. 

Dr. Marshall Hall observes : " It is quite obvious, on trac- 
ing the succession of symptoms, that the first link in the 
chain is constipation, and that the subsequent links are the 
effects of the continued operation of this cause. Ser- 
vants, and especially cooks, are particularly liable to chlo- 
rosis. But the delicate and inert habits of the rich, not 
less frequently lead to this affection. In aril these, there 
is the same defective digestion, assimilation and formation 
of blood.' 5 

" Under the many exciting and depressing influences of 
society, as constituted in our country, and the unexampled 
rapidity with which children become men and women, con- 
stant derangements of health are occurring ; and although 
years are advancing, the constitution suffers great draw- 
backs ; the body does not advance to its full and proper 
evolution at the time nature intended it to attain that con- 
dition. During these intervals of sickness the powers 
of digestion are feeble ; and very delicate and careful 
preparation of the food is necessary, if we would not 
oppress them and greatly hinder recovery. 

" If this be true when comparative facilities exist, what 
shall we say of the condition of those who constitute the 
working classes of our population; whose every day brings 
with it its stern demands of nature for attention to all her 
laws, and the entire time is occupied w 1 '^ toilsome labor ? 

H 



154 CHLOROSIS — TREATMENT. 

The damp cellar, or the stifling attic chamber, in the foul 
atmosphere of some by-lane or street, are not adapted to 
produce appetite, and the wretched occupant, even if for 
the time possessing the means, has no leasure to pay atten- 
tion to the wants of the body. Thus it is from day to day 
that inattention to the unalterable laws of nature, is fol- 
lowed by a condition of listless and wretched indifference, 
and the final appearance of this melancholy disease." 

Chlorosis is not easily confounded with any other dis- 
ease or condition of the body, excepting that arising from 
the loss of much blood. 

Treatment. — As this disease is more or less complica- 
ted with a disordered digestion, much stress has been laid 
upon the efficacy of purgative medicines — and certainly 
they are of great value in assisting a cure. Aloes and 
rhubarb, in combination with iron, are found to be the most 
useful. Dr. M. Hall prescribes a pill, composed of equal 
parts of aloes and sulphate of iron. 

At first a due evacuation of the bowels must be daily 
secured. An injection of a pint of warm water into the 
rectum two or three times a week, is useful in aiding the 
peristaltic action, and removing collections from the large 
intestines. The compound decoction of aloes with the 
compound tincture of cardamoms ; the compound aloetic 
pill, with the oil of cassia ; or the wine of aloes with the 
compound tincture of rhubarb, in appropriate doses, are 
the best forms of purgatives. (Ashwell.) 

The preparations of iodine have been highly recom- 
mended in this disease, and are particularly adapted to 
patients of a strumous or scrofulous habit of body, who have 
glandular swellings. The iodide of iron may be given 
in two grain doses, in solution, two or three times a day, 
or it may be given in form of syrup. But perhaps the 
best form is the compound tincture of iodine, in doses of 
from ten to twenty drops three times a day. These prepa- 
rations should never be taken upon an entirely empty 
stomach, as they are liable to produce heat and oppression. 

Other mineral and vegetable tonics will often be found 
useful. The following form has been used successfully : 

Sub-carbonate of Iron, one ounce. 

Carbonate of Soda, one drachm. 



CHLOROSIS TREATMENT. 155 

Pulverized Nutmeg, two drachms. 

do Liquorice root,.. two do 

do Ginger, one drachm and a half. 

do Cinnamon, one do do do 

White Sugar, half an ounce. 

Oil of Anise, four drops. 

To be thoroughly mixed and pulverized. Dose, a tea- 
spoonful, two or three times a day, in milk. 

Of all medical agents, iron has gained the greatest repu- 
tation in this disease. Dr. Blaud has recommended the fol- 
lowing form as a specific, and all who have given it a 
trial, speak highly in its favor: Sulphate of iron and sub- 
carbonate of potash, of each, half an ounce ; reduce them 
separately to a fine powder ; then mix thoroughly, little 
by little ; add a sufficient quantity of mucilage of gum 
tragacanth ; beat strongly in a mortar, and make a mass, 
to be divided into forty-eight boluses. A mutual decom- 
position of the two salts takes place, which adds much to 
the efficiency of the remedy. A pill should be taken 
early in the morning, and in the evening upon retiring, 
during the first three days. On the fourth, fifth and sixth 
days, a pill should be added at mid-day ; to go on increas- 
ing, till at the sixteenth day, four pills may be taken three 
times a day. It is, according to Dr. Blaud, to be continu- 
ed in this last mentioned dose long enough to dissipate the 
symptoms of the disease, when it should be gradually left 
off. 

Dr. Meigs speaks highly of the following form, to be 
used much in the same manner as the above : 

Citrate of Iron, two drachms, 

Sulphate of Quinine, half a drachm, 

Water, one fluid ounce. 

Mix and take from twenty to thirty drops at a dose, in 
syrup or water, about half an hour after each meal. 

Any one of the vegetable tonics may be given with ad- 
vantage, such as Peruvian bark, cascarilla, gentian, quas- 
sia, etc. 

Counter irritation by blisters, according to the various 
functional disturbances, and medicines mentioned in the 
last chapter, which act upon mucous membranes, are not 



1 56 CHLOROSIS TREATMENT. 

to be omitted. Menstruation may be regarded as a de- 
sirable occurrence, and as soon as the constitution shall 
have been somewhat rallied by these remedies, we shall 
be justified in using some of those medicines mentioned 
in the chapter upon the " suppression of the menses," 
which act directly upon the uterus. 

The ammonial injection, composed of one drachm of 
the pure liquor ammonia to a pint of milk, daily injected 
into the vagina, has proved very efficient. (Ashwell.) It 
is said that chlorosis is frequently cured by marriage. 

The patient should be comfortably clothed with flannel 
next to the skin and take a moderate amount of exercise 
in the dry, pure, open air. The diet should be generous, 
adapted to the condition of the digestive organs ; a free 
use of tamatoes, cooked to the liking, will, from its altera- 
tive properties, be found a good article of food. A mode- 
rate quantity of wine may be allowed, according to cir- 
cumstances. Riding in a carriage and on horse-back, in a 
pure air, are proper modes of exercise ; and pleasant con- 
versation, in addition to the charms afforded by diversity 
of views and landscapes. Boating excursions, music, sea- 
bathing and swimming, etc., are hygienic means which 
cannot be too highly recommended to sad, nervous and 
melancholic women. Travelling, also, and the use of 
mineral waters, taken at the springs, are great advantages. 
The use of tight corsets ought to be forbidden ; sleep 
should not be protracted beyond eight or nine hours, and 
the bed should be neither too warm nor too soft. Exciting 
drinks should be prohibited, as, also, highly nutritious food, 
vivid emotions, the frequenting of balls and shows, the 
reading of high-wrought romances, the examination of 
lascivious pictures, and, in short, all circumstances capable 
of exciting the sensibilities too strongly, should be avoided. 
Sedative drinks, frictions upon the surface of the body, 
and constant diversion, are to be kept constantly in view. 



CHAPTER X. 

f 

HYSTERIA NATURE SYMPTOMS CAUSES VARIETIES — * 

COMPLICATIONS TREATMENT MORAL AND PREVENTIVE 

MANAGEMENT. 

The term hysteria is derived from a Greek word, signi- 
fying womb — from which the disease was formerly suppo- 
sed to arise. Many modern authors suppose the term to 
have been applied with some degree of vaguenesss, and 
that it suggests a theory of the disorder which is some- 
what questionable. 

It has been handed down from Hippocrates, Galen, Van 
Helmont, and many others, that the uterus exercises a su- 
perior power over every other system ; that it presides over 
them with a sway no less capricious than powerful. That 
it not only forms and governs the moral character of the 
female, but creates, exalts, or modifies disease, and regu- 
lates all the physical movements, in every portion of her 
body, etc.; hence the declaration of Van Helmont: On 
account of the uterus, woman is what she is ; and of Hip- 
pocrates : On account of the uterus, woman is all disease. 

In modern times, a superior knowledge of anatomy and 
physiology, as well as of disease, has given us a more ra- 
tional view of the condition and influence of the uterus. 
It is now regarded in importance, only as a viscera of the 
first order. And although its healthy condition is every 
way necessary to the general health of the system, it does 
not seem to exert much more influence, either in a state of 
health or disease, over other portions of the animal econo- 
my, than the stomach and some other important organs. 
The influence of the uterus is greatest during menstrua- 
tion and gestation. 

The seat of hysteria, instead of being the uterus, would 
seem to be in the brain and nervous system ; but the exact 
condition of these organs, necessary to give rise to the va- 
rious phenomena of this affection, is not known. There 



158 HYSTERIA — NATURE. 

is no doubt that a certain morbid condition of the nerves 
of the uterus, may give rise to it ; but that every derange- 
ment of function, or even lesion of this organ will produce 
it, there are unquestionable reasons for denying. Indeed, 
the uterus may be seriously affected, as in cancer, with an 
absence of those distressing symptoms, called "nervous;" 
so, also, in acute inflammation of this organ, there is al- 
most always an exemption from the symptoms constituting 
hysteria. So, it would seem, that there must exist some pe- 
culiar morbid condition of the nerves of an organ, before 
the brain, or nervous system are called into sympathy with 
it. (Dewees.) Dr. Good remarks : " With a morbid con- 
dition of this organ, indeed, hysteria is in many instances 
very closely connected, though it is going too far to say, 
that it is always dependent upon such condition ; for we 
meet occasionally with instances, in which no possible con- 
nection can be traced between the disease and the organs, 
and sometimes witness it in males as decidedly as in 
females." 

The majority of modern authors seem to be inclined to 
the belief that the cause of this malady is to be sought for 
in lesions of the nervous apparatus of the uterine system. 
M. Colombat observes : " If it be allowed us to put forth 
an opinion, as to the probable source of the disease, found- 
ed upon the cases which have fallen under our own obser- 
vation, and which we have compared together, and with a 
great number of others reported by different authors, we 
should say that hysteria, properly so called, has its princi- 
pal seat in the nervous system of the uterine apparatus, 
and that it consists of a special and sui generis mode of 
excitation and perversion of this system,, reacting sympa- 
thetically upon the general nervous system ; we state fur- 
ther, that this peculiar excitation, this morbid modifica- 
tion of the uterine innervation, may itself have for its ori- 
gin, either a local irritation, often inappreciable, or a sym- 
pathetic one, resulting from a moral cause, or from the 
pathological condition of some organ or different appara- 
tus with which the uterus has bonds of union more or less 
direct." 

Dr. Meigs coincides with him in the above opinion, and 
remarks : " Even admitting that the uterus itself, or the 



HYSTERIA— SYMPTOMS. 159 

ovaria, is not at the foundation of the malady, nor the 
disturbing force in the malady, we may readily conceive 
it is in the reproductive tissue, and the reproductive influ- 
ence or power, that is situated the fons et er'igo of the 
evil. I conceive the question to be, not so much whether 
hysteria arises from a disturbing power of the womb, as 
from a disturbing power of the reproductive agencies im- 
planted in the economy ; and I conceive that deviations of 
that power, or those agencies, whether in the male or the 
female, may alike be regarded as ipsissimas causas in these 
maladies." 

Hysteria occurs in females, mostly, during the child- 
bearing period ; it is very rare before the age of puberty 
and after the cessation of the menses. It is observed to 
occur more frequently in single, than in married life, and 
the first attack is oftener at about the period of menstrua- 
tion than any other. 

Those women of a delicate habit, whose nervous sys- 
tems are extremely sensible, are most subject to hysterical 
affections; it also attacks the sanguine and plethoric. 
There is usually a susceptibility, which is acquired by 
inactivity and a sedentary life, grief, anxiety of mind, a 
suppression or obstruction of menstruation, excessive 
evacuations, and a long continued use of an unnutricious 
diet, or of crude unwholesome food. Those who possess 
this susceptibility, are apt to pursue objects with ardor, 
exaggerate grievances, and under the influence of ordina- 
ry emotion are prone to hurried breathing, or to sighing, 
sobbing or laughing. 

Symptoms. — What peculiar condition of the brain exists 
in hysteria, can neither be named, or demonstrated ; yet, 
there is no part of the body that may not have its nerves 
to sympathize with it, calling forth powerful — nay awful, 
phenomena, and a numerous train of symptoms peculiar to 
the part thus sympathizing. Hence, the " Protean shapes" 
this disease is said to assume. It is proper here to remark 
what we wish to have distinctly understood, that it is 
believed females can generally by observation of their 
own peculiarities and by mental discipline, after obvious 
difficulties have been removed, do far more to prevent an 
\ttack, than a physician can do for its relief 



160 HYSTERIA SYMPTOMS. 

The disease attacks in paroxysms, known as "hysterical 
fits." " These are sometimes preceded by dejection of 
spirits, anxiety of mind, effusion of tears, difficulty of 
breathing, sickness at the stomach, and palpitations of the 
heart ; *but it more usually happens that a pain is felt on 
the left side, about the flexure of the colon, with a sense 
of distention advancing upwards, till it gets into the sto- 
mach, and removing from thence into the throat, it occa- 
sions, by its pressure, a sensation as if a ball was lodged 
there, which by authors has been called globus hystericus. 
The disease having arrived at this height, the patient 
appears to be threatened with suffocation, becomes faint, 
and is affected with stupor and insensibility ; while, at 
the same time, the trunk of the body is turned to and fro, 
the limbs are variously agitated; wild and irregular 
actions take place in alternate fits of laughter, crying, and 
screaming ; incoherent expressions are uttered, a tempo- 
rary delirium prevails, and a frothy saliva is discharged 
from the mouth. The spasms at length abating, a quan- 
tity of wind is evacuated upwards, with frequent sighing 
and sobbing, and the woman recovers the exercise of 
sense and motion, without any recollection of what has 
taken place during the fit; feeling, however, a severe 
pain in her head, and a soreness over the whole body. 

" In some cases, there is little or no convulsive motion, 
and the person lies seemingly in a state of profound sleep, 
without either sense or motion. Hiccup is a symptom 
which Hkewise attends, in some instances, on hysteria; 
and now and then it happens that a fit of hysteria consists 
of this alone. In some cases, of this nature, it has been 
known to continue for two or three days, during which it 
frequently seems as if it would suffocate the patient, and 
proceeds, gradually weakening her, till it either goes off 
or else occasions death by suffocation ; but this last is ex- 
tremely rare. Besides hiccup, other slight spasmodic 
affections, sometimes wholly form a fit of hysteria, which 
perhaps continue for a day or two, and then either go off 
themselves, or are removed by the aid of medicine. In 
some cases the patient is attacked with violent pains in the 
back, 'which extend from the spine to the sternum, and at 
length become fixed upon the region of the stomach, being 






HYSTERIA VARIETIES. 101 

evidently of a spasmodic nature, and often prevailing in so 
high a degree as to cause clammy sweats, a pale* cadave- 
rous look, coldness of the extremities, and a pulse hardly 
perceptible." 

Sydenham, as well as most of authors, have remarked 
the numerous varieties and forms under which this disease 
appears, " resembling most of the distempers wherewith, 
mankind are afflicted. 7 ' In whatever part of the body it 
be seated it gives rise to symptoms peculiar to that part ; 
so that if the hysteric ''susceptibility*' be not discerned,' 
such symptoms may be mistaken for some essential dis- 
ease of that particular organ. Thus, if the nerves of the 
stomach be the seat of the sympathy, we shall have eruc- 
tations, sour belchings, pains in that region, indigestion, 
capricious appetite, globus hystericus, etc. If the intes- 
tines, we have spasms, tympanitis, diarrhea or costiveness, 
contractions of the abdominal muscles, etc. If the liver, 
pain in the right side, obstructions or a change in secre- 
tion and flow of the bile, etc. If the kidnies, an immode- 
rate, or diminished secretion and flow of urine, very high 
colored, and sometimes offensive, with severe pain in the 
parts — bloody urine, etc. If the bladder, in continence or 
retention of urine, mucous discharges, etc. If the heart, 
palpitation, faintness, etc. If the scalp, a sense of heat 
on the back part of the head, coldness on top, great ten- 
derness to the touch, etc. Or, if the muscular system be 
the seat, we shall have violent convulsions, twitchings, etc. 

Certain parts, mentioned in this affection, sympathise 
with the brain more constantly and extensively than 
others ; it may be said that the stomach, esophagus, the 
heart, scalp, and kidnies, almost always participate in the 
affection. All of these parts may not be simultaneously 
affected, but they may present themselves separately, and 
• alternately ; in either case, this peculiar disease is betrayed 
and the plan for relief indicated. 

The combination of melancholy and depressing symp- 
toms, which precede hysterical attacks, should serve to 
protect the female from those unkind observations so often 
made by her associates. The predisposing causes, it will 
soon be seen, are most often such as are well calculated 
painfully to excite our symapthy. We have already 

11* 



102 HYSTERIA — VARIETIES. 

spoken of certain departures from moral purity, and they 
may often be the exciting cause of this disease ; but wh.n 
we see it brought upon a delicate and sensitive female, 
from causes originating in domestic unhappiness — it may 
be an unkind or drunken husband, an obstinate child, or 
disappointed affection — we can but most keenly feel for 
her unfortunate condition, and regret the present depart- 
ure from Christian principles, which characterizes our 
social organization. 

• The recurrence of hysteric paroxysms, in those predis- 
posed to them, is generally irregular ; they may at any 
time be developed upon the application of occasional, and 
when the predisposition is great, . slight causes. Violent 
attacks are generally, though not always, accompanied 
with unconsciousness ; at their conclusion, females will 
frequently express a knowledge of the circumstances that 
transpired and lament their inability of the least control of 
themselves. 

We have spoken of some of the variations in this dis- 
ease, but there are yet others more important. Almost 
every kind of serious disease may be simulated by what 
we must call hysteria. And sometimes it requires much 
skill and reflection in order to determine the true import 
of the symptoms, and the real nature of the case. 

One of the diseases which is often copied by hysteria, 
is inflammation of the peritoneum. We find the patient 
complaining of acute pain in the abdomen, aggravated by 
the slightest pressure ; she may have too, a hot skin, and 
a quick pulse. It will be well in such cases, before re- 
sorting to bleeding and the application of leeches, to ascer- 
tain whether all this suffering may not be simply nervous. 
If she be found to have had similar attacks before; if she 
has been known to have hysterical fits ; and if the tender- 
ness be felt as much upon the slightest touch, as when 
firmer pressure is made — after purging the patient, and 
the administration of an assafoetida enemata — the peritonitis 
will soon vanish. 

There are other pains which infest females of the hys- 
teric constitution, which are apt to be erroneously regard- 
ed as inflammation ; " stitches" and pains in the side are 
the most common; There is another, a pain occupying 



HYSTERIA VARIETIES. 163 

some one point in the head, often just' above the eyebrows, 
known as clavus hystericus. In these cases, leeching, 
blistering, etc., for supposed pleurisy or chronic inflam- 
mation of the liver or spleen, may well be spared, since 
they serve to rivet the complaint. 

Palsy is also simulated by this disease. Its being 
mixed up with hysterical symptoms will generally disclose 
the true nature of the affection. Such affections referred 
to the throat are very common ; for example, a loss of 
voice, laryngitis, inability to swallow, etc. In cases of the 
" hysterical breast," the mammae become, painful and ten- 
der ; the girl's fear is excited, and if not understood, her 
attention is anxiously fixed upon it, by local applications ; 
whereas the treatment should be general, and the local 
uneasiness disregarded, or the attention of the sufferer be 
drawn from it. 

Among such affections of the air-passages, there is a 
loud harsh, dry, barking cough ; it occurs in paroxysms, 
and is more annoying to hear than to suffer. Hysterical 
eructation and vomiting are very common. There is also 
bloody expectoration, and even vomiting of blood. None 
of these are dangerous, and the attention of the sufferer 
should be diverted from them as much as possible. 

Hysterical affections of the joints, and bones of the 
spine are also common. Such patients complain of pain 
and tenderness ; and it is now notorious that scores of 
young women have been unnecessarily confined for 
months, and even years, to a horizontal position, and have 
had their backs seamed with issues for supposed disease 
of the bodies of the vertebrae, who had in reality nothing 
the matter with them but hysteria, and who would proba- 
bly have soon ceased to complain, if, instead of being 
restricted to that unnatural imprisonment and posture, 
they had taken a daily gallop on horse-back. It is very 
curious to notice how the mind is apt to become affected 
in these cases ; after the patient has been lying supine for 
months, she is unable to stand or walk; simply because 
she thinks she is unable. The instant she makes a fair 
effort to use her limbs again, she can, and does use them. 
( Watson.) In these cases there is no alternative, and we 



164 HYSTERIA — VARIETIES. 

generally succeed in making them walk ; and then they 
are convinced that they may do so with impunity. 

Dr. Bright was called to see a young lady in affluent 
circumstances, who had been confined to her bed for many 
months. If she attempted to move, she was thrown into 
excrutiating agony, and had nearly lost the use of the 
lower extremities. Dr. Bright being satisfied that it was 
a case of hysteria, substituted bread pills for the medicine 
that she had been long taking, with the same tranquil izing 
effects. He attempted to get her shifted gently from the 
bed to the sofa,, but it was impossible ; the paroxysm 
almost overcame her. " I called" he says, " after an 
absence of nearly a month ; her sister met me at the door 
with a smiling face to tell me that our patient was quite 
well ; and on enquiry, she related how three mornings 
before, under a deep religious impression, she had com- 
pletely recovered all her powers ; and I found her sitting 
up, working and amusing herself, as if she were completely 
convalescent from some ordinary illness." 

Such cases as these suit the purposes of miracle-mong- 
ers. Dr. Watson relates, that a few years ago, the reli- 
gious Journals of a certain party in England, were full of 
an instance of miraculous cure. The patient was a young 
woman with supposed paralysis of the lower extremities ; 
an enthusiastic preacher had influence enough with her to 
make her believe that if on a certain day she prayed for 
recovery with a strong faith, her prayer would be suc- 
cessful, she would recover ; she did so. Many of these 
pseudo-diseases terminate suddenly under strong moral 
emotion. A fall, a fire in the house, overwhelming terror, 
etc., are often found equally efficacious. 

Some of the shapes assumed by this Protean disease, 
are hideous and disgusting. Sometimes paralysis, or 
spasm of the musclar fibres of the bladder, really occurs; 
but it is a common trick of these patients to pretend that 
they labor under retention of urine. No doubt the diffi- 
culty is sometimes real, but it is proved to be oftener feigned 
or exaggerated. It will often disapper, upon the pa- 
tient's being left without pity, to her own resources. Such 
patients are deceitful and obstinate, practising, or attempt- 
ing to practice, the most aimless and unnatural impositions. 



HYSTERIA COMPLICATIONS. 165 

They have been known to swallow their urine and vomit 
it up again, to induce the belief that the secretion had 
taken place in an unnatural way. They have produced 
fragments of common gravel, asserting that these were 
voided with the urine. And a young woman in an 
English hospital, after contriving to make the surgeons 
believe that she had stone in the bladder, actually submit- 
ted to be placed upon the operating table, and tied up in 
the posture for lythoto?ny, before a theatre full of students, 
when the imposture was detected. 

The state of mind evinced by many hysterical women, 
especially when its morbid propensities drive them to 
such acts as these, entitle them to our dee-pest com- 
miseration ; — and, indeed, it is quite impossible for ra- 
tional minds not to pity the unhappy victims of this 
wretched disorder. In distinguishing these aped affections 
from those that are real — if the patient be a young unmar- 
ried woman; if she have any disorder or irregularity of 
the uterine functions; if she have had any former hysteri- 
cal symptoms ; and especially if she be subject to fits of 
hysteria — we may be pretty well assured that the affec- 
tion is hysterical. It is very important, in the treatment, 
not to overlook real disease, when it is mixed with, and 
marked by such symptoms. 

Hysteria is sometimes complicated with those strange 
forms of nervous disorder known as catalepsy and ecstacy. 
These conditions are rare and wonderful : so much so that 
weak and superstitious persons have referred them to su- 
pernatural interposition in human affairs; and stronger 
minded individuals who never have witnessed them, regard 
their occurrence as fabulous, and laugh at them as the 
tricks and cheatings of imposture. They happen mostly 
in the same class of persons as hysteria, seem to be pro- 
duced by similar causes, and resemble it, in seldom being 
attended with danger to life ; their treatment is, also, the 
same. 

Cataleptic attacks occur in paroxysms, and sometimes 
alternate with well-marked hysteria: there is a sudden 
suspension of thought, of sensibility, and of voluntary 
motion; the patient remaining, during the paroxysm, in 
tfic position in which she happened to be in at the instant 
8* 



166 HYSTERIA — COMPLICATIONS. 

of attack, or in the position in which she may be placed 
during its continuance. Dr. Gooch describes a case of it, 
as he witnessed the disease in a patient who had long been 
subject to the common forms of hysteria.' He thus de- 
scribes it : "A few days after our first visit, we were 
summoned to observe a remarkable change in her symp- 
toms ; the attendants said she was dying, or in a trance. 
She was lying in bed, motionless and apparently senseless. 
Her eyes were open but no rising of the chest, no move- 
ments of the nostrils, no appearance of respiration could 
be seen ; the only signs of life were her warmth and 
pulse ; the latter was, as we had hitherto observed it, 
weak, and about 120. 

The trunk of the body was now lifted, so as to form 
rather an obtuse angle with the limbs (a most uncomforta- 
ble position,) and there left with nothing to support it ; 
there she continued sitting while we were asking questions 
and conversing, so that many minutes must have passed. 
One arm was now raised, then the other ; and where they 
were left, there they remained. It was now a curious 
sight to see her, sitting up in bed, her eyes open, staring 
lifelessly, her arms outstretched, yet without any visible 
sign of animation. She was very thin and pallid, and 
looked like a corpse that had been propped up, and had 
stiffened in this attitude. We now took her out of bed, 
placed her upright, and endeavored to rouse her by calling 
loudly in her ears — but in vain. She stood up, but as 
inanimate as a statue. The slightest push put her off her 
balance. No exertion was made to regain it. She would 
have fallen if I had not caught her." 

Dr. Gooch records, that she went into this state three 
several times. The first attack lasted fourteen hours, the 
second, twelve hours, the third, nine hours, with intervals 
of one and two days between them. The patient after- 
wards recovered. 

There is another and milder form of this condition, in 
which the patient is unable to move or speak, but is con- 
scious of all that is going on around. It has been called 
the day mare. 

In what is called ecstasy the state is different. As the 
term imports, the patient is lost to all external impressions 



HYSTERIA COMPLICATIONS. 167 

and is wrapt and absorbed in some high object of imagi 
native contemplation. The muscles are sometimes rigid, 
at others relaxed ; these patients often walk, speak and 
sing. This condition is not uncommon as forming a part 
of religious insanity. An eminent English writer re- 
marks : " Nervous and susceptible persons are apt to be 
thrown into these trances under the influence of animal 
magnetism ; and grave authors assure us that the intelli- 
gence which then deserts the brain, concentrates itself in 
the epigastrium ; or at the tips of the fingers ; that people 
in that state read letters which are placed upon their sto- 
machs, or applied to the soles of their feet ; answer oracu- 
larly, enigmatical questions ; describe exactly their own 
internal organic diseases ; and even foretell future events. 

" I take it for granted that they who were in the habit of 
speaking, a few years since, in some of our places of 
worship, in what they called unknown tongues, were 
either gross imposters, and deserved to be publicly whip- 
ped, or persons laboring under this disease, and wanting 
physic." It is a curious fact that many of the Italian 
Improvisator! are in possession of their peculiar faculty 
only while they are in a state of extatic trance ; and that 
few of them enjoy good health, or consider their gift oth- 
erwise that morbid. 

Hysteria has been confounded with hypochondriasis, 
but the two diseases differ in quite a number of particu- 
lars. Hysteria attacks the sanguine and plethoric as well 
as those of a delicate habit ; comes on soon after puber- 
ty ; its attack is sudden and violent, with globus hystericus, 
etc. We find the reverse in hypochondriasis; it seldom 
occurs till after the age of thirty-five, and attacks the mel- 
ancholic ; comes on gradually ; is a tedious disease and 
difficult to cure ; its effects are mostly confined to the 
canal of the intestines ; and it generally terminates in 
confirmed melancholy. Hysteria is much relieved by 
advancing age, whereas the other is usually aggravated. 

Hysteria is not likely to be confounded with syncope or 
apoplexy, as. the peculiar symptoms which attend it, do 
not occur in either of those conditions. In syncope there 
18 an entire cessation of the pulse, and a ghostly counte- 



168 HYSTERIA CAUSES. 

nance ; in apoplexy there is a sort of snoring, and a quick 
pulse ; which do not occur in hysteria. 

This affection differs from epilepsy, in that this arises 
from a more decided change in the brain ; there is a 
greater distention in the blood vessels of the brain ; a more 
frightful expression of the countenance, and drawing of 
the mouth to one side, rolling of the eyeballs, and grinding 
of the teeth ; while in hysteria the cheeks are red, but at 
rest, and the eye is fixed and quite natural. 

Occasionally, hysteria is combined with some one or 
all of these diseases, and sometimes they are Jie cause of 
unfortunate results ; as persons have remained so long in 
the paroxysm, as to be thought dead, and have actually 
been buried* when life was not extinct. 

The causes of hysteria, are the 'predisposing, or such 
as give to the constitution a susceptibility to the disease, 
and the exciting, or those which more immediately bring 
on a paroxysm, when the susceptibility already exists. 

1. Predisposing causes. It has been observed, that 
whatever destroys the general tone of the system, and in 
particular of the nervous system, especially if this be 
gradually produced, disposes the body to hysteria. Hence 
a too sedentary life ; over- stimulating diet, or much care ; 
the various emotions resulting from social, or unsocial life, 
as it should be called : as disappointed hope, prolonged 
anxiety ; the culture of belles-lettres ; great development 
of the intellect ; a vivid imagination; the abuse of per- 
fumes ; exciting drinks, alcoholic, tea and coffee, etc. ; 
abused affection ; grief; terror, etc., are the most promi- 
nent causes of this kind. Some of these causes act by too 
much exhausting the nervous §ystem, others by taxing its 
sensibilities too highly, and preventing it from acquiring its 
proper tone. Parents who have acquired disease, or de- 
bilitated constitutions, from these causes, are apt to engen- 

* In the year 1745, Lady Russel remained for eight days without giv- 
ing the slightest appearance of life, or the least sign of alteration. She 
was aroused by the sound of the bell of a neighboring church, whilst 
her husband, who vehemently opposed her inhumation, was holding her 
hand and bathing it with his tears ; she lived many years after thi3 
event. J. Raulin, speaks of an hysterical girl, whose funeral he post- 
poned, because her color had not entirely changed. The author adds 
that in the course of a few hours the supposed corpse recovered her 
consciousness. 



HYSTERIA CAUSES. 169 

der this susceptibility in their offspring. Yet the condition 
is more owing to defective physical and moral education 
in early life. 

From the influence of luxury, indolence, and sentimen- 
tal reading, the hysterical susceptibility is becoming a 
common characteristic of the female inhabitants of cities, 
and gaining increased prevalence among the country 
population. A medical writer remarks : " Hysteria is 
undoubtedly mostly due to an indolent, luxurious, and 
enervating mode of life ; and w T e may thank for this those 
(well-meaning though short sighted) persons, who so stu- 
diously oppose every effort for enlightening females upon 
the laws which govern their being, while they fill their 
hands and heads with mawkish and sentimental trash, 
yclept, ' the light literature 5 of the day. This absorbs 
their sleeping and waking moments, to the frequent exclu- 
sion of even a proper attention to the duties of exercise and 
cleanliness. What, then, can be expected, in our enervat- 
ing climate, but a predisposition to nervous diseases ? It 
must and does follow, and may be traced directly to such 
causes." Nothing is more true than this description, and . 
il is sometimes, though rarely, produced in males by the 
same causes. „ . 

The causes of plethora sometimes induce the suscepti- 
bility to hysteria in nervous habits, particularly the con- 
vulsive form of the complaint ; but more frequently f he 
suceptibility is produced by the causes of debility before 
enumerated. In addition to those particularly noticed, may 
be mentioned others — as attacks of fever, excessive evacu- 
ations, or the long-continued use of sedative, depletory, 
or irritating remedies. 

2. Exciting causes. When the susceptibility of the 
nervous system above described exists, a slight excitement 
is often sufficient to induce a hysterical paroxysm. It 
should be remarked that this susceptibility varies in dif- 
ferent individuals ; while some have a '< fix " provoked by 
the slighter causes, others require that they should be 
powerful, or long-continued. 

This condition is more common in women and children, 
than in men ; and more common in all persons when in a 
state of weakness. It is most common in young women, 



/ 

170 HYSTERIA CAUSES. 

in whom, with a debilitated constitution, the process oi 
menstruation is in some way or other disordered. So that 
we find a greater predisposition at the time of the menstru- 
al periods, and immediately after delivery. Consequently, 
sudden suppression of the menses, excessive, and altered 
menstruation as in leucorrhea, may be reckoned as com- 
mon exciting causes, also forced continence, abuse of coitus, 
masturbation, and all circumstances capable of producing, 
maintaining or increasing irritation of the uterus and espe- 
cially of the ovaria. 

Many of those causes, also, enumerated as the predis- 
posing, when they act suddenly, are conspicuous as excit- 
ing causes. Among them may be mentioned, emotions of 
the mind of whatever kind, as sudden grief, anger, fright, 
Joy, or surprise of any kind, unrequited affection, jea- 
lousy, disappointment, reading of novels, erotic conversa- 
tion, the sight of ghastly* and bloody spectacles, sombre or 
too animated music; finally all the causes that produce 
violent emotions, or suddenly recall painful and lasting 
impressions. 

The exciting causes of irritation in some important or- 
gan, are perhaps the most important in reference to the 
treatment, as they are more under the control of remedies 
than emotions of the mind. 

Food, improper in quantify and quality, is perhaps the 
most common cause of irritation ; as highly seasoned and 
exciting dishes ; very salt meat and fish ; iced creams, 
etc. Also, the use of iced and very hot drinks, as tea and 
coffee ; alcoholic drinks, aromatic substances. The old 
proverb, " What is one man's meat", etc., is here partic- 
ularly apposite. The human stomach, at times, is ex- 
tremely capricious, while at others, it will suffer great 
abuses, and for a long time without resistance. In many 
nervous and dyspeptic patients, experience alone, is the 
only safe guide by which the food can be regulated. 

One of the most common symptoms attending hysteria 
is the formation of wind and gas in the stomach and bow- 
els, which is the effect of a certain condition of these parts ; 
one is occasioned by relaxation, which suffers them to be 
distended by the disengaged air, during an imperfect 
digestion ; the other, perhaps, is caused by the secretion, 



HYSTERIA CAUSES. 171 

or elimination of gas from the extremities of the vessels 
terminating upon the internal surface of the stomach and 
intestines. 

Worms in the intestinal canal, and cancerous, as well 
as other-obstructions, as of the liver, spleen, kidnies, etc., 
may act as exciting causes. 

Those who labor under this idiosyncracy of the nervous 
system, no matter how they arrived to it, are peculiarly 
unfortunate ; as they are constantly liable to be affected 
by slight causes, which have no influence on others. Be- 
cause these affections are not often dangerous, and the sub- 
ject of them often enjoys otherwise very good health, she too 
often becomes the object of cruel and ill-directed ridicule. 
Authors mention instances in which such women have been 
thrown into "fits" by the odors of musk, ambergris, and 
even by the rose and lilac, when they could easily bear 
the stronger smell of tobacco. Others have been made, 
violently sick by the very name of rhubarb, Peruvian 
bark, and even coffee. Boyle relates the case of a lady 
who, upon hearing the sound of a bell, or any loud noise, 
would swoon so deeply as scarcely to be distinguished from 
death. Another case is recorded of a young lady who 
always had a hysterical attack if she heard the clock strike 
five — her father having died at that hour. Such and simi- 
lar cases are very numerous. 

The force of imitation is very remarkable in propaga- 
ting this affection : instances in hospital practice are nu- 
merous, wherein a whole ward-full of patients, upon view- 
. ing a hysterical paroxysm, have themselves been attacked 
so violently by it, as to require the most active means for 
rostoring them. 

There is no doubt that certain females, sometimes pre- 
tend hysteric attacks, for the purpose of exciting sympa- 
thy and obtaining the gratification of some desire ; as 
coveted luxuries, compelling the parents consent to desir- 
ed marriages, etc. This is certainly a mortifying disco- 
very, and such cases are easily detected by the physician ; 
they usually declining treatment, particularly if of a disa- 
greeable character. 

Notwithstanding hysteric paroxysms may sometimes be 
extremely awful to behold, they are seldom accompanied 



1 72 HYSTERIA TREATMENT. 

with danger, and the disease never terminates fatally, un- 
less it be complicated with more serious maladies. 

Treatment.- — The treatment of hysteria is divided into 
that which is proper in the paroxysm, and that which is re- 
quired in the intervals, for the purpose of modifying the 
predisposition and removing the exciting causes. 

I. In the 'paroxysm it is important to adopt such mea- 
sures as may be necessary to prevent the patient from sus- 
taining injury during the violence of the struggles. She 
should be in a cool and airy apartment, and have all tight 
dress loosened about her person. When the paroxysm is 
very severe it is not possible to administer remedies by 
the mouth ; but cold water dashed on the face, or the 
cold douch to the head, applied by pouring water from a 
height, from the spout of a tea-pot or other convenient ves- 
sel, will often be useful in rousing the nervous system and 
abridging the paroxsym. For the same purpose, prepara- 
tions of ammonia may be held to the nose, unless there be 
much determination of blood to the head, when it may be 
injurious. As soon as the patient is able to swallow, the 
attack may be shortened by the administration of half an 
ounce of mixture assafoetida, frequently repeated ; or half a 
tea-spoonful of ether, with ten or fifteen drops of lauda- 
num ; or a draught containing a tea-spoonful of the ammo- 
niated tincture of valerian. When the patient cannot be 
made to swallow, great good may be effected by enemata : 
as two drachms of assafoetida and half a tea-spoonful of 
laudanum with half a pint of water, mixed by means of 
the yolk of an egg ; or half an ounce of turpentine, pre- ' 
pared in the same manner; or the same quantity of cold 
water thrown into the rectum, and applied externally to 
the abdomen, will often bring the fit to a speedy termina- 
tion. There is almost always costiveness, or other de- 
rangements of the bowels, for which active purges are 
requisite : the infusion of senna, and castor oil are to be 
preferred. When there is a formation of much wind and 
a tympanitic state of the abdomen, there is no remedy bet- 
ter than the oil of turpentine, by the mouth and rectum. 

Blood-letting has been recommended, but requires to be 
used with caution. When decided signs of plethora exist, 
with much determination of blood to the head during the 



HYSTERIA TREATMENT. 1?3 

paroxysm, the system is put in a better condition for the 
above mentioned antispasmodics, by the previous loss of a 
few ounces of blood. Dr. Whytt thinks that there is no 
remedy so effectual as the warm foot bath, which should 
' be used along with the other remedies. When the parox- 
ism depends upon indigestible food in the stomach, an emetic 
should be given as soon as the patient can swallow. When 
vomiting attends the attack, it should be encouraged by 
draughts of tepid water, until the stomach be cleansed. In 
lingering cases, it becomes necessary to apply sinapisms 
to the feet, and sometimes blisters to the calves of the legs. 
Also, when there is tenderness about the spinal cord, coun- 
ter irritants are very useful. 

When the patient has warning of the approaching par- 
oxysm, it may frequently be interrupted by a timely dose 
of laudanum, assafoetida, or Hoffman's anodyne liquor. 
When landanum disagrees, morphine may be substituted, 
in doses of one- fourth of a grain. 

In those cases where hysteria depends upon a suppres- 
sion of the menses, excessive menstruation, or leucorrhea, 
the treatment must be modified as elsewhere directed. 
(See those chapters.) The patient often receives injury , 
from the violence of by-standers in attempting to unclench 
the hands, etc.; such attempts are highly improper, as they 
are every way calculated to do mischief, and never to do 
good. There should be in attendance a sufficient number 
of persons to control the movements of the patient, with- 
out violence. Every thing should be done quietly, and 
no aggravating remarks should be made to irritate the 
affected person. 

[n the treatment of that long catalogue of affections, 
which are not real, but simulated by hysteria, the cold 
douche is a most valuable resource. Those cases where- 
in limbs are incapable of motion, from having been perma- 
nently contracted for a long time, will generally yield af- 
ter a few •minutes application of cold water. Dr. Clark 
cured a case of locked jaws, after all other remedies had 
failed, simply by placing the head of the patient over a 
tub and pouring cold water on her face. It often requires 
some determination to put this expedient into practice, as 
the patient is apt to look upon the author of it as a mon- 
9 



174 HYSTERIA-— TREATMENT. 

sler of cruelty. - The transmission of electrical shocks 
through the part affected is, also, sometimes effectual. 

In the moral management of hysteria, it is important to 
temper kindness with firmness, and to avoid a parade of ^ 
sympathy. Of all the spasmodic affections, this is most 
readily propagated by sympathy. If, in the large ward of 
a hospital, one girl goes off in a "fit," half a dozen others 
perhaps, or all who happen to possess the hysteric suscep- 
tibility, will have a strong inclination to follow her exam- 
ple. A stern nurse, or an order that the cold affusion, or 
some more disagreeable application, shall be employed, 
will keep the complaint greatly in check ; and on the other 
hand, great sympathy with such patients has a striking 
effect in encouraging the paroxysms. These facts show 
that the "fits" are not wholly wilful, neither are they 
wholly conquerable. (Watson.) 

2. Respecting the management of hysteric patients in 
the intervals — after having spoken of the remedies most 
beneficial for giving tone and firmness to the system in 
treating of deranged menstruation, leucorrhea and chloro- 
sis — we have here but little to say. The great object to 
be aimed at, is the restoration of the nervous system to the 
requisite degree of stability, necessary to overcome the 
acquired susceptibility. 

The mind, if possible, should always be diverted from 
the contemplation of the ills of the body. A due inter- 
course with society, in such a manner as to divert without 
exciting, is desirable. The patient should be aware, that 
for a cure, vastly more depends upon her judicious man- 
agement of the moral faculties, and proper employment of 
the physical powers, than can be effected by medicine ; 
she should be informed how much depends upon herself, 
by not yielding to sudden impulses, emotions of the mind, 
and destructive forebodings. The physical, exciting 
causes, improper practices, or whatever they may be, 
should also be avoided. 

The remedies must be directed to the nervous system, 
through the medium of the stomach, skin, and the mind. 
They will consist of tonics, antispasmodics, the cold bath, 
and agreeable impressions «on the mind. The tonics will 
consist of the various bitters, preparations of iron, iodine 






HYSTERIA TREATMENT. 175 

and food ; such as Peruvian bark, sulphate of quinine, 
gentian, orange peel, columba and quassia ; the carbon- 
ate, sulphate, citrate and wine of iron ; the compound 
tincture and syrup of iodine, etc. The antispasmodics, 
are asafoetida, valerian, ether, castor, etc. The food 
should be only such as agrees and is easy of digestion ; 
such as poultry, mutton, venison, soft boiled eggs, tomatoes, 
and bread made from unbolted wheat flour. 

Much good may be expected from the steady employ- 
ment of the shower bath. The bowels must be kept regu- 
lar, by the employment of aperients composed of aloes and 
rhubarb ; a constant attention to this is most important. 
An attention to the following points is also of great conse- 
quence : a well regulated course of exercise, both on foot 
and on horse-back*; the avoidance of hot rooms and late 
hours, both in respect to going to bed, and to rising from 
it ; the avoidance of moral emotions, of novel reading and 
of all the other numerous modes of mental and bodily dis- 
sipation, which accompany and lessen the blessings of 
civilization. Marriage sometimes proves a cure ; when 
this is the case it is probably by satisfying the affections 
of the heart. 

The susceptibility to hysteria, may be more -easily pre- 
vented than cured ; in a great majority of instances it is 
the result of injudicious management in early life. Pa- 
rents do not foresee the misery they are laying up for their 
daughters, in pampering them with stimulating food, allow- 
ing modes of dress which unduly compress the most im- 
portant organs of life, and filling them with fashionable 
accomplishments. Too much time is devoted to sedentary 
employment, and the perusal of works of fiction is too 
often substituted for more solid attainments, which pro- 
duce a fondness for injurious excitement. 

We will close this chapter by quoting some remarks 
made upon this point by Sir B. Brodie. After remarking 
that no better service can be rendered society, than by 
explaining to parents how much the ordinary system of 
education tends to engender the disposition to this disease 
among their female children, he says : " The boys are 
sent at an early age to school, where a large portion of 
their time is passed in taking exercise in the open air ; 



L76 NYMPHOMANIA NATURE. 

while their sisters are confined to heated rooms, taking 
little exercise out of doors, and often none at all, except- 
ing in a carriage. Then for the most part, the latter 
spend much more of their time in actual study than the 
former. The mind is over educated at the expense of the 
physical structure ; and after all, with little advantage to 
the mind itself; for who can doubt that the principal ob- 
ject of this part of education ought to be, not so much to 
fill the mind with knowledge, as to train it to a right exer- 
cise of its intellectual and moral faculties ; or that other 
things being the same, this is more easily accomplished in 
those whose animal functions are preserved in a healthy 
state, than it is in others. 



CHAPTER XL 

NYMPHOMANIA, OR FUROR UTERINUS NATURE — CAUSES- 
SYMPTOMS AND TREATMENT. 

By nymphomania or furor uterinus, is understood, an 
exaggerated, voluptuous sensation, accompanied by vene- 
real desire, which is irresistible and insatiable. We have 
spoken of a complaint, (Chapter VI. Part 11.) pruritus of 
the vulva, which has been often confounded with this affec- 
tion, though it is of a very different character. 

Some authors have placed the seat of this disease in the 
brain, while others fix it in the genital organs. Modern 
authors, however, amongst others, M. Colombat, in whose 
opinion we ourselves agree, regard it as resulting from a 
simultaneous irritation of the brain and sexual organs. 
The above named author, observes : " This morbid exag- 
geration of the venereal appetite, this cestus eroticus, is less 
a disease than a symptom, for the manifestation of which, 
is required the concurrence of the brain and the organs to 
which erotic sensations are referred. The point of depart- 
ure is sometimes in the brain, and sometimes in the uterus 
and its appendages. In the former case, the disease is 
developed under the influence of moral causes which 
secondarily irritate the genital parts, and in the latter, it 



NYPHMOMANIA NATURE. . 177 

is a primary irritation of the organs of generation reacting 
sympathetically upon the brain, and especially on the 
cerebellum. 

u The affection, which may appear at all ages, gener- 
ally attacks women of an original uterine temperament, 
which is determined by the predominence of the sanguine 
system, and extreme irritability of the abdominal viscera. 
Women of this constitution have certain characteristics ; 
their stature is small, their skin dark, and their complex- 
ion highly colored ; in them the breasts and all the attri- 
butes of puberty have been developed at an early period ; 
the clitoris and the nymphae, which are generally of 
abnormal length, are endowed with exquisite sensibility. 
Young widows, who have to regret frequent engorgements, 
public girls who have been suddenly deprived by forcible 
seclusion of venereal pleasures, to which they had aban- 
doned themselves to excess, ardent women, married to men 
whose cold and feeble constitutions prevent often- repeated 
sexual connexion, and finally those who are attacked 
with some chronic cerebral affection, are most exposed to 
this frightful disorder, especially when they inhabit warm 
climates, in which the passions are most vivid and the 
imagination most exalted." 

The genital organs of some women, acquire such a 
preponderance, as to make it always impossible for them 
to control the intensity of the erotic flame which devours 
them ; such was the young girl of whom Buffon speaks : 
* I have seen, and I have regarded her as a singular phe- 
nomenon, a girl of twelve years of age, a dark brunette, 
of a bright and highly colored complexion, of small sta- 
ture, hut already fully formed, with a rounded neck and 
embonpoint, perform the most indecent action at the simple 
appearance of a man ; nothing could control her in this, 
neither the presence of her mother, nor remonstrances, 
ncr punishments. Yet she did not lose her reason, and 
the attack, which was carried to such a point as to be 
frightful, ceased the moment that she remained alone with 
women.'' Such also, was the shameful and disgusting 
Messalina, who was accustomed to escape during the night 
from the bed where slept her stupid lord, the Emperor 
Olaudius, and disguised in the dress of a courtezan, 

I 



178 . NYMPHOMANIA CAUSES AND SYMPTOMS. 

hastened to encounter the brutality of the vilest debauch- 
ery. 

Causes. — These may be divided into the predisposing 
and exciting, or those which act upon the brain, and second- 
arily the sexual organs, and those whose action is felt 
primarily upon the uterus and its appendages. 

In the former, should be included all circumstances 
capable of producing an exaltation of excitement in the 
brain and nervous system; such as the reading of lasci- 
vious and impassioned works, viewing of voluptuous 
paintings, romantic conversations, associating with corrupt 
companions, frequent visits to balls or theatres ; disap- 
pointed love ; the too assiduous cultivation of the fine arts ; 
the influence of imitation on beholding it in others ; the 
abuse of aphrodisiac remedies, or of spirituous liquors, or 
of aromatics and perfumes which excite too much the brain 
and general sensibility. 

The causes whose action is directly upon the genital 
organs, and which may afterwards react sympathetically 
upon the brain, are masturbation, the abuse of coition, 
pruritus of the vulva, inflammation of the nymphse, clitoris, 
neck of the uterus and ovaries; we may add, the irrita- 
tion of ascarides in the rectum ; and finally the use of 
drastic purgatives, and the internal or extensive, external 
employment of cantharides. 

Symptoms. — At first the female experiences venereal 
iesires, especially at the periods of menstruation, which 
her prudence induces her to conceal. The care which 
she takes at this period to hide the obscene ideas that con- 
. stantly disturb her imagination, renders her sad, taciturn 
and melancholy ; she loses her appetite and sleep, and 
seeks solitude. After the disorder has made some pro- 
gress, far from seeking to hide her irresistible passion, 
the patient employs all her address to make it known by 
frequent sighs, by encouraging proposals, by voluptuous 
attitudes, and finally by complete forgetfulness of all 
modesty. At the sight of one of the male sex her pulse 
is agitated, her face becomes more animated; her respira- 
tion hurried, her senses are obscured, she makes indecent 
gestures and proposals ; finally, when the paroxysm is at 
its height, she strikes and tears everything that opposes 



NYMPHOMANIA TREATMENT. 179 

her, and at last falls into furious delirium. There are 
certain other symptoms, as a sensation of pruriginous heat 
in the loins, hypogastrium and breasts ; the genital parts, 
which are red, swollen and constantly irritated from hand- 
ling and illicit manoeuvres, are generally the seat of a 
fetid, and sometimes a purulent discharge. Finally, there 
is ardent thirst, grinding of the teeth, spasm of the eso- 
phagus, and, in some cases hydrophobic symptoms. The 
attacks of furor uterinus frequently follow each other with 
great regularity, and sometimes terminate fatally ; espe- 
cially is this the case when there is organic disease of the 
uterus or its appendages. 

We remarked that nymphomania had been confoundec 
with pruritus ; but they are generally easily distinguish a 
ble. In the former there is a voluptuous sensation, ac- 
companied by venereal desire. Pruritus on the contrar)* 
is characterised by an indomitable itching, seldom accom- 
panied by voluptuousness ; indeed, there is most often, 
great repugnance to venery. 

Treatment. — This is to be applied, according to the 
seat of the malady, to the brain and nervous system, to 
the reproductive organs, or to both. 

In general, greater good may be expected from hygiene 
than from drugs, which are not. so successful in opposing 
a disease whose source lies in moral causes. Some means 
of diversion should therefore be devised, capable of turn- 
ing aside her imagination from lascivious thoughts ; for 
this purpose, should be recommended constant occupation 
of some kind, travelling, walking, etc. The reading of 
romances ; balls and shows, the society of men ; the view- 
ing of voluptuous statuary; and every thing capable of 
producing erotic excitement, should be avoided with the 
greatest care. Their thoughts, if possible, should always 
be employed with something foreign to their passion, and 
they should be allowed only to associate with persons of 
their own sex ; they should take frequent and prolonged 
warm baths, with cold affusions to the head, while in the 
bath. They should use cold and sedative drinks, emul- 
sion of almonds and marsh mallows with nitrate of potash, 
or a few grains of camphor, and enemata of the same na- 
ture ) finally, whey, broths made of beets and sorrel, and 



1 80 NYMPHOMANIA TREATMENT. 

of chicken or veal with nitre 3 lemonade ; a milk and 
vegetable diet, etc. 

General bleeding, and the application of leeches to the 
back of the neck, or behind the ears, are useful, especially 
when the brain is considerably affected. Frequent saline 
purging, is also not to be neglected. 

When the disease depends upon local causes, as vene- 
real excitement, masturbation, leucorrhea, prurigo, the 
presence of worms, etc., in addition to the above, seda- 
tives may be applied with good success ; as injections of 
starch or mucilage with laudanum, decoction of poppy- 
heads, of cicuta, of hen bane, etc.; or cloths saturated 
with any one of these may be applied to the genital parts. 
Also the employment of enemata of milk with a few 
grains of camphor, and the careful internal administration 
of camphor and opium will be found useful. Finally, for 
the purpose of quelling the erotic desires, Dr. Coster has 
proposed the employment, internally of tartar emetic, one 
or two grain* in a pint of water, to be taken in teacupful 
doses, ever}' hour, so as to excite nausea, without occa- 
sioning vomiting. 

Everything capable of exciting the genital organs must 
be studiously avoided ; soft mattrasses, feather beds, and 
beds of down must be forbidden, and those made of straw 
or simple hair mattrasses, substituted. In desperate cases 
it is sometimes necessary to use an apparatus, a sort of 
wire work, whose meshes are so close as to prevent the 
passage of the finger. Let us repeat, that the strictest 
regimen should be observed, a milk and Vegetable diet, 
with abstinence from stimulating food and drinks of every 
description. During the intervals of calm, the patient 
should be reminded of her duty to herself and family, 
which is dishonored by her shamefnl practices, and, also, 
how much depends upon her own efforts in controlling her 
propensities. Though marriage has sometimes proved a 
remedy for nymphomania, it is a means that should only 
be resorted to when we are fully assured of its applica- 
bility. 



CHAPTER XII. 

HYSTERALGIA, OR IRRITABLE UTERUS SYMPTOMS CAIUi^ 

AND TREATMENT. 

This disease, known, also, as neuralgia of the uterus, 
is principally characterized by pain in that organ ; it was 
first described by Dr. Gooch, who defines it, " a painful 
and tender state of the uterus, neither attended by, nor 
tending to produce change in its structure." By writers 
anterior to his time, it was confounded with, and regarded 
as a kind of chronic inflammation. 

This disease occurs in females of every temperament, 
and may appear at any time within the menstrual age; 
the young and middle aged, however, are most subject to 
it — the aged being rarely attacked. 

Symptoms. — This affection, at times, is one of extreme 
suffering. There is pain in the lower part of the abdomen 
and loins, which usually comes on a few days before or 
after menstruation, and from which the patient is never 
quite free. It is subject to aggravations, from mental 
excitement and bodily exertion ; hence the patient is in- 
duced to give way to the relief afforded by repose. The 
result is, that by the pain, the want of exercise and fresh 
air, the general health is broken ; and a languid circula- 
tion, constipation and dyspepsia are super-induced. 

Upon examination, the uterus is found tender from slight 
pressure. Sometimes the neck and body are slightly 
swollen, but not hard; the mouth of the uterus, and vagi- 
na are found healthy. The disease may continue for 
months or years, it may be subdued by medical treatment, 
or it may subside spontaneously. It is a sure cause of 
barrenness, but it does not terminate in organic disease of 
the uterus, or endanger life. 

Leucorrhea sometimes, though not always, accompanies 
this disease. It may be distinguished from acute and 
chronic inflammation of the uterus, by the absence of 



182 HYSTERALGIA CAUSES AND TREATMENT. 

heat and throbbing, and by the stationeriness and long- 
continuance of the symptoms, without a tendency to dis- 
organization of the organ. From " painful and difficult 
menstruation" it is distinguished by a continuance of the 
pain, more or less severe, throughout the interval. From 
displacements of the uterus and vagina, by the natural po- 
sition of those organs in this affection. 

From a comparison of this malady with long-continued 
and painful affections of other parts of the frame, it must 
be inferred to be nervous. Thus, the breasts, the spine, 
and the various joints, may be the seat of acute pain, 
which may endure for many years without being accom- 
panied by organic change. 

The causes of this disease are often obscure. The 
most appreciable are, bodily exertion during menstruation, 
or too soon after abortion and delivery ; excessive coition, 
and an improper use of astringent injections. It may, 
also, come on after great fatigue merely, such as long 
journies, dancing, dissipation, late hours, etc. 

Treatment. — There are few diseases so tedious of cure 
and*liable to relapse, as this. The indications are — 1. to 
relieve the pain ; 2. to restore the constitutional condition. 

1. The violence of the pain must be allayed by abso- 
lute rest during the paroxysm, and narcotics, such as opi- 
um, hyosciamus, morphine, etc., either alone or in combi- 
nation, with camphor or asafcetida. If the stomach be 
too irritable, they will be found equally as efficacious by 
injection into the vagina or rectum. Opium and bella- 
donna plasters, or hop and poppy fomentations, to the sa- 
crum and abdomen, are also useful. Counter irritation 
should be practiced by means of small blisters or dry cup- 
ping to the loins. Much relief will be afforded by vaginal 
injections of warm water alone, or a solution of morpnine 
(two grains to the ounce,) if the pain be severe. The 
warm hip bath, will often procure relief. The bowels 
should be kept open, by the mildest means, as all active 
purgation in this disease is invariably injurious. 

2. Athough, during a severe paroxysm of pain, close 
confinement is indispensible, in the horizontal posture, 
this should not prevent the patient from being often carried 
into the open air and taking moderate carriage exercise, 



IIVSTERALGIA — TREATMFNT. 183 

particularly as soon as there is an abatement of the most 
violent symptoms. A generous diet, but so as not to 
burthen the stomach, fresh air, and a gradual course of tonic 
medicines, (iron preparations are preferable,) are the best 
means of treating the constitutional condition accompany- 
ing this obstinate disorder. 

There is another affection of the uterus, much resem- 
bling this, which might be, perhaps, more properly named 
rheumatism of the womb. The plan of treatmeat is the 
same as above recommended. 



There is a painful state of the vagina sometimes met 
with, analagous to the affection of the uterus just described ; 
and which might be termed Irritable Vagina. It is char- 
acterized by extreme tenderness, when the lining mem- 
brane is touched by the finger, and a hysteric attack not 
unfrequently follows coitus. In some it is developed by mar- 
riage, and in others by child-bearing, or both. The treat- 
ment is. mainly the same as above directed for Hysteralgia. 



SECTION II. 

ORGANIC DISEASES. 



CHAPTER I. 

INFLAMMATION OF THE UTERUS FALLOPIAN TUBES AND 

OVARIES ACUTE AND CHRONIC CAUSES SYMPTOMS 

TERMINATIONS. AND TREATMENT. 

The diseases of the internal genital organs which 
w r e have hitherto considered, are the functional ; and are 
not attended with structural changes of so serious a nature 
as to prevent a complete restoration. The line of distinc- 
tion between the functional and organic is not always so 
apparent as might at first appear. This arises from the 
complications to which all of these disorders are more or 



184 INFLAMMATION OF THE UTERUS CAUSES. 

less subject, which give them a tendency to produce dis- 
organization. The diseases of these organs now to be con- 
sidered, are the organic ; and though mostly curable in 
their earlier stages, they are far more serious than the 
other class, often, for a long time, resisting the best appli- 
ances of art for their relief. 

Inflammation of the acute form, in the unimpregnated 
uterus is a rare disease; chronic varieties, however, are 
frequently met with. It may attack the mucous or serous 
coats alone, or in connection, the proper tissue of the ute- 
rus ; it may occupy the body or the neck, or both. Its 
occurrence is very rare, till after marriage, and it scarcely 
ever appears before the age of puberty. 

Causes. — Blows externally and local contusions most 
frequently give rise to it; it is oftener produced soon after 
marriage, than at any other period. Cold taken during 
menstruation by improper exposure, may, by suppressing 
the secretion, convert the periodic congestion which pre- 
cedes the eruption of that discnarge, into active inflamma- 
tion. 

Dr. Colombat enumerates the following causes : " Irri- 
tating injections ; suppression of the discharge of piles ; 
leucorrhea ; the use of violent medicines to force the 
menses, or to procure abortion ; too frequently repeated 
coitus ; relative disproportion of the organs ; solitary en- 
joyment; celibacy; widowhood; sudden cooling of the 
extremities ; cold bathing of the lower parts of the body ; 
cold general baths, and iced drinks, especially during 
menstruation; fatigue walks; violent exercise on horse- 
back, or in carriages without springs ; excessive dancing ; 
loss of sleep ; wounds ; the application of a pessary ; heat- 
ing and stimulating food ; spirituous drinks ; coffee ; wine ; 
and strong moral disturbances, which may suspend the 
flow of the menses, of the lochia, etc. 

Symptoms. — In the acute form, the attack commences 
with chills, succeeded by feverishness, heat and uneasiness 
in the pelvic region, and pain in the back and lower part 
of the abdomen, extending to the groins, and down to the 
thighs. There is more or less tenderness on pressure. 

Upon examination, the uterus will generally be found 



INFLAMMATION OF THE UTERUS SYMPTOMS. 185 

increased in size, and often somewhat depressed in the 
pelvis ; the mouth more open than natural, and the neck 
tender to the touch. 

The constitutional symptoms vary ; there is seldom 
much fever, and though the pulse may be somewhat 
quicker, than usual, it is very often unaffected. The 
menses sooner or later become suppressed, when we 
have all the symptoms consequent upon that condition. 

The local irritation is soon imparted to the neighboring 
organs ; the vagina, rectum, urethra and bladder partici- 
pate, giving rise to pain and difficulty in discharging the 
faeces and urine. 

Distant organs also sympathize ; the breasts swell and 
become painful ; there is nausea with a diminished appe- 
tite ; the bowels become constipated ; and the general 
health differs very much. 

Chrome inflammation of the uterus is much more im- 
portant than the acute ; not only from its more frequent 
occurrence, but also from its being often found complicated 
with various other organic diseases of this organ, adding 
to the distress, and accelerating their progress. It is often 
very insidious, giving irregular indications of its presence ; 
we may have nearly all the symptoms enumerated under 
the acute form, but they are less marked. 

The causes of the chronic form, may be divided into 
predisposing and exciting ; the latter are the same as enu- 
merated under the acute form. The predisposing causes, 
are depressing moral emotions, a scrofulous constitution, 
or lymphatic temperament, syphalitic diathesis, a cancer- 
ous predisposition, improper aliments, dwelling in low, 
damp and unventillated places, tight corsets, and reading 
novels which produce uterine phlogosis. 

Menstruation is more or less disturbed, and there is often 
a vaginal discharge. This slow inflammation, from the 
sympathetic influence of the uterus when irritable may 
give rise to a variety of nervous symptoms ; the female 
becomes fretful and capricious, and often hysterical. 
Such symptoms may also indicate otheT serious affections 
of an obscure character, and comparitive rare occurrence ; 
so that it often becomes necessary for the female to sub- 
mit to a manual examination, for the purpose of ascertain. 

I* 



188 INFLAMMATION OF THE UTERUS TREATMENT. 

ing the real condition of things. No female should neg- 
lect to submit at once to a step so necessary for her proper 
treatment; as, of course, the utmost propriety is observed 
by every gentleman who is obliged to resort to such an 
examination. 

" We may often justly suspect the existence of this slow 
inflammation of the uterus, from the fretful and capricious 
disposition of females who have previously been of an 
equable and happy temperament. It was said by the an- 
cient physicians, that the i uterus was an animal within an 
animal, 5 so well were they convinced of its surprizing 
power over the affections and sentiments. Nor does it 
seem at all inconsistent with the perfect harmony of na- 
ture's laws that it should be so. When we reflect on the 
inconceivable wonders of its functions — that within its 
cavity, nature, with her plastic hand, gives the first evi- 
dence of her power to attach an immortal spirit to those 
very elements of which the meanest insect, or even a blade 
of grass is, also, formed — we may, with great propriety 
demand why the whole organism should not respond to its 
slightest affection." 

Inflammation of the uterus frequently terminates in reso- 
lution. There are other conditions, however, consequent 
upon this disease, which, though rare, from their import- 
ance, deserve notice. 

The uterus may become indurated or enlarged, either 
temporarily or permanently ; the former is supposed fre- 
quently to give a disposition to cancer. This augmenta- 
tion in volume, may, from its pressure upon the bladder 
and rectum, give rise to incontinence of urine and consti- 
pation. It, also, favors displacement of the organ. 

This disease may, also, terminate in softening of the 
substance of the uterus ; in abscess and gangrene — though 
rarely. It may be distinguished from other organic dis- 
eases of this organ by a thorough examination, and inves- 
tigation into all the symptoms. 

Treatment. — The activity of the treatment will depend 
upon the severity of the attack and upon the constitution 
of the patient. Venesection will only be necessary where 
there is considerable fever. 

In the acute form, cupping the loins, or leeches to the 



INFLAMMATION OF THE OVARIA AND TUBES. 157 

vulva, to be repeated if necessary, will be found useful. 
Or the leeches may be applied directly to the uterus itself 
by means of the speculum, as advised by French authors. 
Mild saline purgatives will, also, be necessary to evacuate 
the bowels. Benefit has been derived in this form from 
the administration of opium and tartrate of antimony in 
combination (one grain of opium to one-fourth grain of the 
antimony, in pill) repeated every hour or two, till sleep 
was obtained. Diaphoretics are always useful, as liquor 
acetate ammonia, and Dover's powder. Local poppy fo- 
mentations^ and hip baths, frequently repeated, are. also, 
useful ; as, also, are vaginal injections of decoction of 
poppies with a small quantity of laudanum. 

In all chvonic cases, as well as acute, after the employ- 
ment of antiphlogistic remedies, much benefit may be de- 
rived from counter irritation to the loins, by means of 
mustard poultices, croton oil, etc. If blisters be used, 
the flies should be carefully removed before the vesication 
takes place, or tissue paper interposed, to prevent stran- 
gury. The application of leeches, or scarification at the 
mouth of the uterus is, also, very useful in this form. 
When permanent thickening, or enlargement of the uterus 
has taken place, along with a proper dietetic regulation, 
great benefit may be expected from the exhibition of iodine. 
The use of it, in some of its various forms should be per- 
severingly prolonged. The diet must be simple yet nour- 
ishing. The patient, if married, must live absque marito, 
and strenuously avoid excitement of every description. 
At an advanced stage, all means should be employed which 
are calculated to improve the general health. 



Inflammation of the Fallopian tubes and ovaria, 
sometimes occurs independently of affections of the uterus ; 
most freqeuently, however, from their proximity to the latter, 
they are anvcted by an extension of the more acute disorders 
of the uterus. Under these circumstances, no good would 
result -from giving an extended description of the disease, 
as the causes, symptoms and treatment are about the same 
as just enumerated. The exact seat of the affection can 
rarely he detected till after death. 

The Fallopian tubes may be attacked by acute inflam- 



188 SIMPLE ULCERATION OF THE UTERUS. 

mation, which may pass into the chronic form and terminate 
in the formation of pus ; the abscess may open into the 
peritoneum and prove fatal, or it may discharge externally ; 
or, the inflammation may give rise to adhesions and oblite- 
ration of the canal of the tubes, — thus cutting off all com- 
munication between the uterus and ovaria, rendering the 
woman barren. 

The ovaria are, also, liable to attacks of inflammation 
which may terminate in softening or abscess. Under these 
circumstances, there is more or less pain, tenderness and 
swelling of the side ; and from five to ten quarts of pus 
have been discharged. The abscess may burst into the 
peritoneum and prove fatal ; but it more frequently estab- 
lishes- a communication with the uterus, bladder or rectum, 
and thus escapes externally. 

During the acute stage of these attacks, active antiphlo- 
gistic remedies and fomentations must be employed accord- 
ing to the severity of the symptoms ; in the chronic form, 
we should have recourse to counter irritation, the use of 
iodine internally, etc. — as directed under " inflammation 
of the uterus." 



CHAPTER II. 

SIMPLE ULCERATION OF THE NECK OF THE UTERUS CAUSES, 

SYMPTOMS AND TREATMENT. 

There is a chronic inflammation of the neck of the ute- 
rus followed by simple ulceration, which is much more 
common than inflammation of the womb generally, des- 
cribed in the last chapter; though it is not often that the 
symptoms become so marked as to excite the fears of the 
patient, till after the ulcerative process has commenced. 
If an opportunity be afforded at an early period,, of ex- 
amining with the speculum, a circle of a deep red color, 
having a puffy feel, with small superficial specks of ulcera- 
tion, will be observed around the mouth of the uterus. 

The disease is not confined to any one temperament, but 
occurs mostly during uterine activity, and more frequently 






SIMPLE ULCERATION OF THE UTERUS TREATMENT. 189 

after sexual commerce has given the uterus additional ir- 
ritability. The ulceration is mainly confined to the neck, 
and is often owing to local irritation from shocks to which 
this part is exposed ; and, as might be expected, prosti- 
tutes are particularly obnoxious to it. 

The causes are, local irritations from pessaries, contri- 
vances to prevent conception, etc. In addition to these, 
cold taken during menstruation, from insufficient clothing 
and wet feet ; the improper use of astringent injections ; 
masturbation, etc., are prominent causes. 

The symptoms, during the inflammatory stage, are occa- 
sional shivering, alternating with heat ; a dull pain and 
weight in the loins and lower part of the pelvis, with itch- 
ing of the external parts ; and sometimes the abdomen ap- 
pears swollen. The presence of leucorrhea, especially 
later in the disease, is not uncommon. 

The mouth of the uterus is found more open than natu- 
ral, and tender upon pressure ; marital intercourse is 
attended with severe pain. All these symptoms are aggra- 
vated upon the occurrence of ulceration. 

Upon examination, by passing the finger carefully over 
the ulcerated surface, a degree of roughness, with depres- 
sion will be felt, unless it be very superficial'. When the 
finger is withdrawn it will generally be covered with a 
yellowish white matter, sometimes streaked with blood. . 

The disease is distinguished from the corroding ulcer 
by the limited depth and extent of ulceration, absence of 
hemorrhages, by the discharge being inodorous and the 
constitutional symptoms not severe ; whereas, in corrod- 
ing ulcer, we find an aggravation of all these symptoms. 
What constitutes the difference between these affections, 
or whether the conversion of simple ulceration into corro- 
ding ulcer ever occurs, it is at present impossible to say. 
This we know, that the former is comparatively of trifling 
moment, while the latter is of such malignancy as to des- 
troy a great part of the uterus, despite of all our efforts. 

It is distinguished from cancer by a comparative mild- 
ness of all the symptoms. Also, from syphilitic ulcer by 
the irregular boundaries and rough edges of the latter. 

Treatment. — During the inflammatory stage, active 
measures may anticipate ulceration. Cupping the loin?, 
9* 



190 SIMPLE ULCERATION OF THE UTERUS TREATMENT. 

or the application of leeches to the vulva, or to the neck 
of the uterus itself, should be immediately resorted to. 
This should be followed by hip baths, emollient vaginal 
injections, and the exhibition of saline laxatives; and when 
this is done, counter irritation to the sacrum, by blisters, 
etc. By these means, the swelling and tenderness of the 
neck may often be lessened. 

When ulceration has taken place, emollient vaginal 
injections should first be used; then the milder astrin- 
gent ones may be tried ; such as sugar of lead, sulphate of 
zinc, copper, etc. Or astringent ointments may be applied 
directly to the ulcers by means of the speculum; such as 
the sugar of lead, etc. 

If the disease resist milder remedies and have made con- 
siderable progress, it will be necessary to cauterize the 
ulcerated surface. This is best done by the use of the 
Speculum, when the caustic* may be applied to the seat of 
the disease, without injuring healthy parts. The nitrate 
of silver, butter of antimony, nitric acid, or caustic iodine 
may be applied in this manner, great care being taken to 
limit the application to the parts affected. Some have been 
very successful in the use of the per-nitrate of mercury, 
applied by the means of a camel-hair pencil. These 
medicines judiciously employed rarely fail of giving relief. 

Occasional bathing will be useful throughout the dis- 
ease. The bowels must be kept in a soluble condition 
by mild aperients, without purging. When the general 
health appears to suffer, the internal exhibition of sarsa- 
parilla, and other alteratives should not be neglected, 
though the principal reliance must be placed upon local 
applications. 



*])r. Lisfrank hns mentioned the following circumstances as forbidding 
the us** of caustic : 1. If there be much engorgement of the uterus; 2. 
If there be HufHcieril inflammation to give rist to pain; 3. The caustic ii 
not to be applied within four or five duys of the appearance of die 
menses, nor for three or lour days afterwards. 



CHAPTER III. 

PROLAPSUS OF THE UTERUS NATURE — CAUSES — SYMPTOMS 

AND TREATMENT. 

The situation of the uterus and its mode of support,, 
when maintained in the normal condition, are admirably 
adapted to the functions it has to perform. It possesses four 
ligaments, which are broad expansions of the peritoneum, 
fixing it to the sides of the pelvis, which are of necessity 
elastic, being adapted to the purposes of child-bearing. 
These very circumstances, though sufficient under the con- 
ditions designed by nature for retaining it in place, in our 
present perverted state of existence render it peculiarly 
liable to displacement. Most, or all of the debilitating 
causes so often adverted to in this volume, to which females 
are subject, are concerned in giving rise to a state of sys- 
tem decidedly favorable for the supervention of this condi- 
tion. In addition, the uterus is subject to the impulses 
and pressure of the abdominal and pelvic viscera. The 
bladder, with which it is so intimately connected, may . 
exceed its natural fulness and push the uterus backwards ; 
while the rectum when excessively loaded may act in the 
same manner in the opposite direction. The vagina, an 
organ of diversified function, may become relaxed and 
permit a descent within or through its canal of the prolap- 
sed womb. Add to these causes the relaxation of the 
perineal muscles and abdominal walls and the weight, and 
alteration of position of the uterus, during pregnancy, in- 
dependently of tumors, and there can be no wonder that 
the uterus, of all the organs of the body, is most exposed 
to displacement. 

It may be thought somewhat out of place to treat of 
some of the displacements of the womb in this place, they 
being so intimately connected with pregnancy and partu- 
rition ; but we think, that the convenience of not separat- 
ing the discussions on these subjects, more than counter 



192 PROLAPSUS OF THE UTERUS NATURE. 

balance any considerations of this nature, and have 
preferred to give them all in one view. 

In this chapter we shall speak of prolapsus of the uterus, 
which is the most common form of displacement to which 
the womb is subject. The other forms will be treated of 
in succeeding chapters. 

This displacement of the uterus has been designated by 
various terms : Prolapsus, Procidentia, and "falling down 
of the womb" are the most common. It consists simply 
in a depression of the uterus below its natural level in the 
pelvis. To an adequate understanding of all the circum- 
stances which may influence this condition, it is important 
to be acquainted with the natural situation of the womb, 
and its relation to surrounding organs. See Figs. 2 and 
3 with descriptions at page 22 and 27. 

The uterus is situated nearly in the centre of the cavity 
of the pelvis, its mouth being from four to six inches from 
the external parts. Its body is supported by the broad 
and rounded ligaments, while its neck rests upon the 
vagina ; so it is evident that this organ cannot descend 
without a rupture, or extension of its ligaments (the latter 
takes place) and except by pushing the vagina before it, 
or by passing itself into the canal of the vagina. 

Prolapsus may be divided into imperfect and perfect, for 
the purpose of indicating different degrees of displacement. 
By the former is signified, that though the uterus has 
advanced considerably downwards it continues to remain 
within the cavity of the vagina ; by the latter, that it has 
descended below the orifice of that canal so as to com- 
pletely protrude beyond the labia, turning the vagina in- 
side out. The symptoms- of each differ little, except in 
intensity. 

Every degree of prolapsus of the uterus is met with, 
from those cases in which the mouth of the uterus descends 
a little lower than its natural situation, to others wherein 
the mouth of the organ projects th rough the external parts, 
dragging with it the vagina, and forming a large tumor 
between the thighs of the woman equal in size to a ki.'ge 

melon." Tin's will cause an alteration in the relative 
situation of the parts within the pelvis and of the abdo 



PROLAPSUS OF THE UTERUS CAUSES 193 

minal viscera, both regarding each other, and also, the 
containing parts, as the parietes of the abdomen and the 
bones of the pelvis. Tiie bladder instead of being retained 
in the pelvis, falls down into the external tumor dragging 
with it the meatus urinarius ; so that in order to introduce 
a catheter into the bladder, the point of the instrument 
must be turned towards the knees of the woman. The 
rectum instead of following the curve of the sacrum, first 
dips down into the posterior part of the tumor, and after- 
wards ascends into the pelvis. The Fallopian tubes and 
ovaria will of course, be dragged down with the uterus, 
and the centre of the tumor will be filled up by the small 
intestines which hang down into it (the messentary being 
stretched) — whilst the omentum will occupy any vacant 
space which may be left. (Clark.) 

It occurs in all ranks, and most frequently in females be- 
yond the middle age, who have borne children. (Churchill.) 
It has been met with in women who have not borne children, 
and even in maids. (Capuron.) Dr. Monroe mentions a 
case which occurred in a child three years of age. Of 
all the chronic diseases arising from a local cause, to 
which women in civilized society are liable, prolapsus 
uteri, or displacement of the womb, 'is perhaps the most 
frequent. (Hamilton.) 

Causes. — The immediate causes of this disease are — 1. 
Relaxation of the broad and round ligaments above. 2. A 
want of due tone in the vagina below. By the first the 
uterus is permitted to fall, and by the second the uterus 
is allowed to be received into the cavity. (Clark.) 

The relaxation of the muscles at the floor of the pelvis, 
and of the vagina is probably the more important cause. 
After repeated leucorrhea, monorrhagia, repeated child- 
bearing, etc., the levator-ani muscles, and the canal of the 
vagina, become much debilitated and the walls of the 
uterus with its ligaments become less resisting than before. 
Weakness and loss of power of the supporting muscles of 
the floor of the pelvis, and of the abdomen, in consequence 
of general debility of the system are unquestionably the 
most prominent causes. These muscles from their rigidity 
and contractile powers, are essential aids in keeping the 
organs of the abdomen and pelvis in their relative position 



194 PROLAPSUS OF THE UTERUS— CAUSES. 

and sustaining them against the contractions at stool 
during labor, and of the diaphragm above. Every time 
we breathe, sneeze, cough, etc., the diaphragm is forced 
downwards, which presses the intestines upon the uterus 
and bladder; and if the natural supports of these organs 
be any way weakened it is easy to conceive that their 
displacement is inevitable. 

In addition to the causes of prolapsus, incident to a 
married life, such as increased weight of the uterus in 
pregnancy, ill-managed labors, walking too soon after 
delivery or abortion, etc., a prominent place in the list, is 
due to those causes referred to in almost every chapter of 
this volume, which exhaust and debilitate the female 
constitution in early life ; they are defects in physical 
education ; precocious excitement, physical and mental ; 
masturbation ; too early marriage ; improper diet, dress, 
etc., etc. 

" The mania that exists for precocious education and 
marriage, causes the years that nature designed for corpo- 
real development, and corresponding intellectual vigor, to 
be wasted in the restraints of dress, the school and the 
ball-room. With a body not half clothed, and a mind 
intent on pleasure, the hours designed for sleep are per- 
verted by the midnight revel. * * When one is finished, 
another in perspective keeps the mind morbidly sensitive 
to impression, whilst the constant restraint of fashionable 
dress absolutely forbids the exercise indispensable to the 
attainment of organic strength. Exposure to midnight air 
with a- body reeking from the effect of dancing in an 
overheated room, produces its inevitable effect ; and at 
last, an early marriage and premature confinement, cap 
the climax of her misery ; and the unfortunate female, 
hitherto regardless of the plain dictates of unerring nature, 
becomes an unwilling subject for medical treatment. 

" The barbarous corset is a powerful cause of produc- 
ing the disease. It presses the bowels directly upon the 
uterus, and prevents a proper and healthful circulation of 
blood in the lungs ; thus reducing the general health, and 
causing congestion and leucorrhea. Frequent abortion is 
likewise a fertile cause ; excessive dancing, and various 
improprieties heretofore alluded to. Nothing is more 



?Tlo. APSUS, 01 IHE UTERDS SYMPTOMS. 195 

common amongst those who work in mills and manufac- 
turing establishments, where the fresh air is shut out, and 
the body overworked in constrained and awkward posi- 
tions." 

Symptoms. — These are sympathetic in the earlier stages, 
and afterwards mechanical, arising from the displacement 
of other organs, and the pressure of the prolapsed uterus 
upon them. 

Those women of irritable constitutions, who have been 
tenderly and luxuriously brought up, 4 suffer much even 
from slight sinking of the uterus; while strong women 
almost entirely disregard these early inconveniences, and 
complain but little even when the organ is entirely pro- 
lapsed, of large size, and ulcerated. Dr. Ashwell, upon 
this point, remarks : "A lady, wealthy and self-indulgent, 
from over-exertion in dancing, while the catamenia were 
present, displaced the uterus very slightly, so slightly that 
in a day or two it was only just resting on the perineum ; 
yet she never stirred off the sofa for a month. At the same 
time, I had under my care a poor woman, earning her 
living by carrying vegetables on her head to and from 
market, whose uterus, as large as a good sized melon, was 
entirely out of the vagina, and ulcerated. She merely 
wanted to be relieved from the acrimony of the discharge, 
scarcely complaining at all of the mechanical inconveni- 
ence of weight and position. Doubtless, relaxation of 
the organ frequently exists without being recognized, as 
the early symptoms of lumbar weight and uneasiness, are 
too common to be soon attributed to displacement. But 
when these have continued long, nausea^ loss of appetite, 
constipation and flatulence being added to them, suspicion 
is excited. It is then found that standing or walking ag- 
gravates the symptoms, and that the recumbent posture 
alone gives certain and immediate relief. Aimost constant 
leucorrhea and occasional stranguary, claim attention. 
Thus, week after week passes away, and remedy after 
remedy is tried ; the patient ultimately soliciting an ex- 
animation, that the disease being accurately made out, 
something more curative may be tried." 

Menstruation, though sometimes disturbed, is often regu- 
lar and rarely complicated with hemorrhage. As long a* 



196 PROLAPSUS OF THE UTERUS SYMPTOMS. 

the uterus is retained in the vagina, there is no impedi- 
ment to impregnation; cases even, are on record, where 
impregnation and delivery have been safely effected while 
the uterus was beyond the vulva. 

If the womb descend to the external orifice, and espe- 
cially if it protrude, there is much pain and distress in 
the pelvic region, and difficulty in voiding the urine and 
faeces; in some cases, this can only be accomplished by 
the woman's first lying down and returning the uterus to 
its natural situation. The recumbent position gives relief 
from the distressing sensations, but not from the prolapse. 
The patient is seldom free from leucorrhea, which gradu- 
ally diminishes her strength. Attacks of menorrhagia 
occasionally occur, but are rare. 

The appetite becomes irregular, or is totally lost; the 
stomach and bowels lose their tone, and become greatly 
distended with air ; the spirits are depressed ; every em- 
ployment becomes irksome, and life itself is considered 
scarcely desirable. There are, however, a variety of shades 
in the degree of this sympathy. (Clark.) 

Upon examination, in imperfect prolapsus, the womb can 
be felt by passing the finger through the vaginal orifice ; 
its mouth will be discovered at the bottom of the tumor ; 
and the vagina will be found relaxed, dilated and thrown 
into folds. If the prolapse be perfect, the uterus will be 
discovered by separating the labia ; it is usually conical 
or pear-shaped. The tumor is seldom very large in those 
cases where the patient, upon lying down, is in the habit 
of returning it into the pelvis ; but when this is neglected, 
or not possible, it sometimes attains a very large size. 

In all cases of prolapse, the mouth of the uterus will be 
found at the lower part of the tumor; attention to this fact 
will always serve to distinguish it. If there be any doubt 
in i\gard to it, from its resemblance to polypus tumors, 
ire can make sure of its being the mouth of the womb by 
the careful introduction of a bougie. The protruded 
• organ will have lying on its anterior wall the bladder, the 
whole being covered by the everted vagina. Generally, 
the tumor is firm and elastic to the touch ; it preserves 
its delicate pink color when frequently returned into the 
pelvis; but when long exposed to the external air, it bo- 






PROLAPSUS OF THE UTERUS TREATMENT. 197 

comes dark red, or brown. It is peculiarly exposed to 
irritation and pressure, giving rise to superficial ulceration, 
forming additional distress to the already severe sufferings 
of the patient. Such ulcerations have been known to as- 
sume a gangrenous apppearance, and cases are on record, 
in which the uterus has been completely separated and 
came away, and yet the patient recovered. The sack 
formed behind the prolapsed uterus and vagina often acts 
as a receptacle for the fluid discharges. 

Treatment. — When left to nature alone, prolapsus of 
the womb may soon become quite incurable, for its ten- 
dency is always to increase, and the chances of success 
are always more unfavorable as the case is of longer date, 
the descent greater, and the concomitant circumstances 
more disadvantageous. As the simple depression of the 
womb, or prolapsus in the first stage, generally produces 
but slight inconvenience, it happens that the natural, but 
unreasonable delicacy of the female makes her fearful of 
confiding her complaint to the medical attendant, prefer- 
ing to leave in the hands of nature the care of a malady 
of whose evil tendencies she is ignorant. There are w t o- 
men, it is true, who conceal this painful infirmity for years 
together, and even attain to an advanced age Without any 
very serious symptoms. And there are others, in whom the- 
womb cannot be reduced, either in consequence of its hav- 
ing been delayed so long as to give rise to adhesions, or from 
its containing within its cavity a foetus of several months, 
or from other insurmountable obstacles, or such at least as 
are connected with circumstances that may lead to the 
sudden death of the patient. This disorder might, per- 
haps, never compromise the life of the patient, were it not 
that by neglect the mischief has a tendency to increase 
and extend — simple depression soon becoming a positive 
falling, and finally, a complete prolapsus — and for certain 
complications that always aggravate the prognosis, which 
of itself is bad enough ; thus, a descent and relaxation 
of the vagina; a deformity of the pelvis; a dropsy; a 
state of marasmus ; the presence of a cancer upon the 
neck of the uterus, or of polypus in the cavity of the 
womb, or of a foetus ; a stone in the bladder, are so many 
complications changing the indications of treatment always 
10 



198 PROLAPSUS OF THE UTERUS TREATMENT. 

to the disadvantage of the patient, and liable to become 
fatal, not only by preventing the reduction of the tumor, 
but, also, by necessitating certain operations and certain 
peculiar cares. (Colombat.) 

In the treatment, there are two principal indications : the 
first is, to replacet he organ in its natural position ; and 
the second is, to prevent the recurrence of the displace- 
ment. In the milder cases, we can often succeed by act- 
ing medicinally upon the mucous membrane : in the se- 
verer ones, we are obliged to have recourse to mechanical 
support. 

In imperfect prolapse, it is generally an easy matter to 
restore the uterus to its natural position ; all that is neces- 
sary is, to have the patient lie upon her back, with the 
pelvis elevated somewhat higher than the head, allowing 
the abdominal muscles to relax as much as possible. The 
reduction may be often facilitated by the introduction of 
two fingers into the vagina, and gently pushing the womb 
towards its natural place. 

After the reduction, along with rest in the horizontal 
posture, providing no signs of inflammation appear, should 
be prescribed, with a view to the radical cure, the use of 
cold astringent injections to be repeated two or three times 
a day, and hygienic means for the restoration of the gene- 
ral health. The lower part of the abdomen, the genitals 
and the back may be sponged with cold water, and an 
injection (a pint) of cold water may be thrown up the 
vagina morning and evening. The patient should remain 
in the recumbent position, and receive the injection gently 
and slowly, by means of an appropriate syringe, or an 
elastic bottle. Various kinds of astringents have been 
recommended, all of which should be used with care. 
The most useful are, the decoction of oak bark, green tea, 
galls, rind of pomegranite, infusion of roses, etc.; the sul- 
phate of copper or zinc, (half a drachm to a pint of water,) 
nitrate of silver, (from one to ten grains to the ounce of 
water,) alumn, (half a drachm to the ounce,) etc. 

The improvement of the general health always has a 
marked and favorable influence upon this affection ; there- 
fore, our attention in all cases should be carefully directed 
to it. Aromatic purgatives, with alteratives, tonics, and 



PROLAPSUS OF THE UTERUS TREATMENT. 199 

an appropriate diet, will be useful, and a well directed 
course of diversion in the country. 

In complete prolapsus of the uterus, or where it protrudes 
through the external parts, its reposition is more or less 
difficult. As preliminary, the patient should empty the 
bladder and rectum, either spontaneously or by means of 
the catheter, and common enema. If the uterine tumor 
be found swollen and painful, as frequently happens, from 
the action of the air, the urine, and the clothing, emollient 
poultices should be applied to it, and the swelling may be 
reduced by fomentations, baths, venesection, dieting, dilu- 
ent drinks, laxatives, etc., according to circumstances. 

The parts having been brought into a proper condition 
and the patient placed as before, the uterus should be 
gently though firmly pressed upwards by the hand, (pre- 
viously well oiled,) and when within the vagina, one or 
two fingers should be introduced in order to push the womb 
into the cavity of the pelvis. 

Should there be considerable difficulty in the reduction, 
all efforts ought to be suspended till there is some diminu- 
tion in the sensibility and size of the tumor ; this may be 
brought about by prolonged rest in the horizontal posture 
and a continued application of the remedies above men- 
tioned. No matter how severe or of how long standing, 
all hopes of reduction should not be soon renounced ; yet 
it should be remembered that there may be cases in which 
it is impossible, and that ill-advised and severe efforts 
have brought on fatal inflammation. 

If reiterated efforts should render it evidently impossi- 
ble to restore the womb to its proper place, we must be 
content with giving due support to the tumor, by means 
of a proper suspensory bandage, which should be anointed 
with cerate ; a bandage of oiled silk, doubled, seems best 
to answer this purpose. Should an irreducible prolapsed 
uterus be attacked by extensive gangrene and sloughing, 
the propriety of amputating the womb at the neck, must 
be decided upon, which, though a formidable operation, has 
been safely performed. The circumscribed ulceration 
which frequently takes place, should be treated by emol- 
lient poultices and astringent applications. 

When prolapsus takes place at an advanced stage of 



200 PROLAPSUS OF THE UTERUS— -TREATMENT. 

pregnancy, the reduction should, nevertheless, be attempt- 
ed as before ; it may be easily effected at an early stage. 
The bladder and rectum should be evacuated as before 
directed, and it must not be forgotten that the introduction 
of the catheter is frequently no easy matter, from the dis- 
tortion of the parts ; in some cases, recourse must be had 
to the male catheter, as the female instrument will not at 
all answer the purpose. When pregnancy is so far ad- 
vanced as to render such attempts imprudent, all we can 
do is to give proper support to the womb, by means of a 
-suspensoiy bandage, and advise the patient to observe the 
horizontal posture, in bed ; and when her full period has 
arrived, the delivery of the child should be facilitated, by 
sustaining the prolapsed organ, and assisting the dilatation 
of the mouth of the uterus. After the child is born the 
reduction may be easily effected. 

There is one important point which it is necessary for 
pregnant females afflicted with this malady to understand. 
The prolapsed womb, from its pressure on the bladder, 
almost always gives rise to suppression of the urine ; this 
may be^obviated by passing up a finger behind the symphy- 
sis bubis, and pushing back the womb so as to relieve the 
urethra and bladder of such pressure. 

We have now spoken of the mode of reducing prolapsus 
of the uterus under different circumstances; there always 
yet remains an indication, that of retaining the womb in 
its proper position, by the use of pessaries ; which are of 
different shapes, dimensions and materials. Where the 
affection is recent, this supporting instrument is not abso- 
lutely indispensable, but it is for the most part so, when 
the woman is of a large size, and the disorder is of long 
standing or considerably advanced. 

Pessaries of various kinds are used, either of sponge, 
glass, cork, boxwood, ivory, gold, silver, or of gum elastic. 
Those in common use are flat, round, oval, or globular, 
with a hole in the centre, to allow the escape of any dis- 
charge. The best, are probably the globe, and flat or rath- 
er, the disc-like, pessaries made very light, either of gold 
or silver washed with gold. The glass pessary sometimes 
answers a very good purpose. "A good pessary, 5 ' remarks 
Dr. Clark, " should combine firmness, lightness, and close- 



PROLAPSUS OF THE UTER r JS — TREATMENT. 201 

ness of texture : firmness, that it may not yield to pres- 
sure ; lightness, that it may not incommode by weight ; 
and closeness of texture, that it may not imbibe the secre- 
tions of the vagina." 

The mode of introducing a pessary is very simple. 
After the evacuation of the bladder and rectum, as previ- 
ously directed, the patient should lie upon her left side, 
with the knees drawn up, and a pillow between them. The 
pessary should be dipped in olive oil, and pressed against 
the external mouth with a gentle force, occasionally sus- 
pended, so as to give time for the vagina to dilate. Some 
time should be required to place it at the mouth of the 
uterus, for if it enter too readily, or with too little force, 
it is liable to be expelled at the first bearing down in evacu- 
ating the rectum or bladder. It would be well for the 
female, awhile after the introduction, not to go out with- 
out the ?iapkin, lest in some sudden fit of coughing, sneez- 
ing, or laughter, the instrument might be forced from its 
place, to her mortification and dismay. 

The irritation excited by the introduction of a pessary 
should be counteracted by rest, diet, baths, enemata, emol- 
lient and opiate injections ; if these be not sufficient, the 
instrument should be temporarily suspended. Women 
should remember that the presence of such an instrument 
in the vagina requires the most scrupulous attention to 
cleanliness. They should bathe frequently, and have 
recourse to the daily use of vaginal injections of cold wa- 
ter. It should be withdrawn once in three or six months, 
or if there be much discharge, once in two or four weeks 
will not be too often. 

When from any cause, pessaries cannot be made use 
of, there are other resources, the principal of which, is 
the use of some one of the numerous patterns of utero- 
abdominal supporters, sold in almost every village through- 
out the Union. An operation has been proposed for the 
permanent cure of this affection, which resembles the one 
adopted for prolapsus of the anus.' It consists in removing 
a portion of the vaginal mucous membrane, and uniting 
the opposite edges of the wound, so that when healed, the 
calibre of the canal shall be diminished. 

We should remark that the plan of treatment, by rest in 



202 INVERSION OF THE UTERUS. 

the horizontal posture very long continued, is apt to 
exhaust the muscular force of the patient, and thus prove 
an injury instead of being a benefit. In slight cases of 
prolapse, a method calculated to invigorate the general 
health, would be far more likely to produce a cure, than 
dependence upon a pessary, which is, perhaps indispen- 
sable at an advanced stage. Hence, such patients should 
take exercise in the open air, live upon a nutritious diet, 
with wine and malt liquor ; avoiding all depressing and 
injurious circumstances, disregarding as much as possible 
the annoying sensations proceeding from the prolapsus ; 
tonics and aperient enemata may also be necessary, as 
well as vaginal injections of astringent solutions ; and 
when the general health improves, the local disorder will 
generally lessen, and finally disappear. 

Some authors have recommended a subsequent preg- 
nancy, as a means of obtaining a radical cure of this 
malady ; and indeed, women are frequently restored to 
perfect health by it, who have been much distressed by 
prolapsus of the uterus for several years. 



i \ CHAPTER IV. 

INVERSION OV THE UTERUS — CAUSES — SYMPTOMS AND TREAT- 
MENT. 

Inversion of the uterus differs widely from prolapse ; 
for, while the organ is equally depressed in both cases, in 
the former, the womb is turned inside out ; the fundus 
losing its position, sinks perpendicularly inwards and down- 
wards, till it passes through the mouth, forming a tumor 
between the thighs; while in prolapsus the mouth is 
always at the lower part of the tumor. The ovaries, 
Fallopian tubes and intestines occupy the space formerly 
filled by the womb, and the sack is lined internally, by 
peritoneum, while it is covered externally, by the mucous 
membrane of the uterus. 

Inversion is the most dangerous of the uterine displace- 
ments, but happily the most rare. Writers have recog- 



INVERSION OF THE UTERUS CAUSES. 203 

nised three varieties of the disease. A simple depression 
which takes place when the top or fundus of the womb is 
somewhat indented like the bottom of a glass bottle. 2. 
Incomplete inversion, when the uterus has descended into 
the vagina. 3. Complete inversion, where the uterus 
protrudes externally with the mouth above, and the fun- 
dus below. Authors have also divided the malady into 
acute and chronic. 

Causes — These are mostly connected with child-birth. 
It has* been observed to follow very quick labors, espe- 
cially if the patient be delivered standing, or make too 
violent efforts : or, it may occur after a natural labor, as 
the result of a peculiar condition of the uterine fibre. The 
most common causes are violent extraction of the placenta ; 
forcible pulling of the cord, while the placenta is still 
attached to the womb, and the pressure of the intestines 
upon the fundus at the same time ; prolonged efforts at 
bearing down, with the view of more speedily expelling 
the placenta ; and shortness of the cord, or its being twisted 
around the child's head or body. 

This affection may also arise from, or follow dropsy of 
the womb ; the walls being relaxed, thin and weakened, 
yield readily to the impulsion of the bowels by'the contrac- 
tion of the diaphragm, and of the abdominal muscles. A 
large tumor of the fundus may, by its weight, descend 
through the mouth of the uterus, dragging the fundus along 
with it, and thus producing complete inversion. 

Symptoms. — These are always serious and alarming, 
indicating the important nature of the accident. Immedi- 
ately after the inversion there is sudden exhaustion and 
sinking ; the countenance becomes deadly pale, the voice 
weak, the pulse rapid, small and fluttering, accompanied 
with nausea, vomiting, and the patient is threatened with 
the immediate loss of life. These symptoms often depend 
upon the loss of blood which takes place, but not always. 
There are sometimes nervous symptoms, and even con- 
vulsions. 

Hemorrhage to a very large amount not un frequently 
occurs ; violent uterine contraction almost always takes 
place, immediately preceding, or accompanying the inver- 



204 INVERSION OF THE UTERUS TREATMENT. 

sion ; there is also great pain, with a dragging sensation 
from the loins, and occasional retention of urine. 

Upon examination per vaginam, a tumor will be found 
either in the cavity of the pelvis, or hanging through the 
vulva. This tumor will be globular, and possess a rough 
bleeding surface. If the displacement be not reducible, 
it sometimes happens that the tumor becomes strangulated, 
running on to gangrene, and ending in the death of the 
patient. If the inversion be complete, we may acquire 
further information from a visual examination ; the tumor 
is at first red, but gradually becomes of a dull brown. 

The foregoing are the most prominent symptoms of 
acute inversion ; those which characterise the chronic 
stage of the disease, are of course much less formidable. 

Inversion is easily distinguished from prolapsus of the 
uterus : in the former there is no mouth of the uterus infe- 
riorly, but a rough and bleeding surface. 

As we have before intimated, inversion of the womb is 
a dangerous accident, that may prove speedily fatal, if 
there be the least delay attending its reposition. Not- 
withstanding some women have been known to live a long 
time with a complete inversion, unreduced, it generally 
happens that the few who do survive, drag out a misera- 
ble existence, and perish at last from profuse leucorrhea 
and repeated attacks of flooding. The reposition of the 
inverted organ becomes more and more difficult the 
longer it is delayed, and often becomes wholly impossible. 
There are examples, however, going to show that the re- 

Sosition has been performed as late as the fifth and eighth 
ays, and even much later ; also, the organ after being 
long inverted has been known to reduce itself spontane- 
ously. 

Treatment. — The first object should be to reduce the 
displaced organ instantly ; and if it be attempted as soon 
as the accident occurs, it is in general not very difficult. 
Every hour increases the difficulty ; and the lapse of four 
or five days may render it impossible ; though there is a 
great difference, according as the inversion is complete or 
incomplete. It has been spontaneously reduced even 
when the displacement was complete. 

But no anticipation of such a result will justify our 



INVERSION OF THE UTERUS TREATMENT. 205 

losing a moment in attempting to replace the uterus. The 
fundus of the protruded uterus should be indented, and 
passed in through the vaginal orifice, follwed by the hand, 
(previously well oiled) in the form of a cone, up through 
the neck and mouth of the uterus; the hand should be 
made to press mainly upon the fundus of the organ, and 
should not be withdrawn till the vagina shall have been 
put upon the stretch, when, if still further pressed it some- 
times suddenly starts from the hand like an india-rubber 
bottle when turned inside out, and the organ is restored to 
its natural position. The hand, which is now in the 
cavity of the uterus, should not be withdrawn, but be 
allowed to-be expelled by the uterine contraction; we 
should first, however, be sure that the restoration is com- 
plete. 

When the placenta remains attached to the womb at the 
period of inversion, it will often be found impossible to 
reduce the uterus, until it is removed; this should be 
done bv pealing it off with the fingers, acting from the 
edges towards the centre. When the tumor is in danger 
of strangulation, from powerful contraction of the neck of 
the uterus, it has been recommended to divide it with a 
bistoury. Unless the reduction be attempted at the mo- 
ment the accident occurs, the bladder and rectum should 
be previously evacuated. If the inverted womb and the 
neighboring parts should be much swollen, or if the patient 
be feverish, it may be necessary to apply leeches and 
poultices or foment the parts before attempting the reduc- 
tion. 

Notwithstanding the disease be of seme days standing, 
we should not look upon the reduction as hopeless ; no 
means likely to effect so desirable an object, should be left 
untried, as attempts have been successful, after days and 
even weeks have elapsed. It should be remembered, 
however, that there is a point, beyond which, a continu- 
ance of the attempts would only be injurious to the patient 
by aggravating all the symptoms. Sometimes it happens 
that the inflammation may be resolved by palliating the 
distress of the patient, and the organ remains irreducible 
without giving her any great inconvenience. 

After we succeed in restoring the uterus to its natural 



206 RETROVERSION AND ANTEVERSIOX. 

action, great care is requisite to avoid a recurrence of the 
accident. The patient should remain for some time in the 
horizontal position, with the pelvis elevated, the knees 
bent and the head low. Opium should be administered, 
and stimulants, according to circumstances. 

When reduction cannot be effected, and the disease runs 
on to gangrene, the suppuration should be promoted and 
the symptoms allayed by emollient fomentation and injec- 
tions of cinchana, camphor, chloride of soda, and tonics, 
internally. But should the symptoms be so severe as to 
greatly endanger life, the womb may be removed, either 
by the ligature, or direct amputation. 

The operation by ligature is most often preferred,' and 
consists in applying a cord, (silk is preferable) or silver 
wire, around the tumor at the highest part, and gradually 
tightening as the patient may be able to bear it, until 
the tumor is entirely detached. Or two ligatures may be 
used, passed through the centre of the neck of the tumor, 
each one including half. The pain, nausea and vomiting 
must be treated with sedatives, and when violent, the liga- 
ture should be temporarily loosened. The strength of 
the patient must be maintained by a nutricious, though 
not stimulating diet. We need not remark that this is a 
dangerous operation, and should not be resorted to on 
slight occasions. 

We should observe that when inversion is complicated 
with polypus, the latter must first be treated as elsewhere 
directed. (See that chapter.) 



CHAPTER V. 

RETROVERSION AND ANTEVERSION OF THE UTERUS CAUSES, 

SYMPTOMS AND TREATMENT. 

The terms retroversion and anteversion, have been 
applied to those cases in which the fundus of the uterus 
has been found displaced posteriorly and anteriorly. As 
the causes, symptoms and treatment of these two displace- 



RETROVERSION AND ANTEVERSION CAUSES. 207 

rnents are very nearly the same, we have thought best to 
speak of them under one head. 

In retroversion of the womb, the fundus is earned to- 
wards, and lodged in the hollow of the sacrum, while the 
mouth is brought forwards, and upwards behind the gym- 
is pubis. In anteversion, the fundus is directed 
towards the symphysis pubis, and the mouth towards the 
sacrum. The former is frequent, while the latter is much 
more rare. 

Retroversion is most frequently met with in pregnant 
women ; anteversion, on the other hand, is rare in preg- 
nancy, and is not very frequent in the unimpregnated ute- 
rus, though both diseases may occur at any age of female 
life after puberty. 

Causes. — The causes that predispose to gradual dis- 
placements, are a natural mobility of the womb, a certain 
smallnessof the pelvis, or a largeness of the same, a deep 
curvature of the sacrum, and the pressure of the bowels 
upon the fundus, and upon one of the sides of the 

Where the retroversion takes place suddenly, it is 
caused by over-distention of the bladder with urine ; vio- 
lent and sudden contraction of the abdominal muscles and 
diaphragm, from vomiting, or the expulsion 'of the urine 
and feces ; external violence, as a fall, a blow, and sud- 
den fright, causing a violent convulsive movement of the 
diaphragm. 

A woman who allows her bladder to become enormous- 
ly distended, will render herself liable to retroversion 
during its continuance, especially if she happen to be 
engaged in a fit of laughter, sneezing or coughing. A 
jump from a carriage step, or a chair, or a trip on the 
pavement, while the womb is pushed backwards by the 
full bladder, may suddenly and even instantly jam the 
uterus under the promontory of the sacrum, which is fol- 
lowed by bearing down efforts, every repetition of which 
aggravates the mischief. If the woman be unimpregnated, 
perhaps she will empty the bladder, and the womb raised 
upwards again by its ligaments is not suspected to have 
been retroverted ; but if she be pregnant, at two and a 
half or three and a half months, and the fundus be once 
jammed below the promontory, it will probably remain 



208 RETROVERSION AND ANTEVERSION SYMPTOMS, 

there, even after the bladder shall have been perfectly 
emptied by the catheter. Let a woman, two and a half 
months gone, get into a stage or rail car, having neglected 
to evacuate the bladder beforehand, if she get off on her 
ride with eight or twelve ounces in the organ, and is pre- 
vented for some hours from relieving herself, she will 
hardly reach her journey's end without having retrover- 
sion ; arid when she attempts to relieve the bladder, is 
found to labor under a total suppression of urine, or at 
least, a most painful dysuria. (Meigs.) 

The causes of anteversion, are increased weight of the 
fundus of the uterus in consequence of an engorgement ; 
constipation, giving rise to large collections in the rectum ; 
painful labor ; vomiting ; great fatigue and violent shocks. 

The mechanism of anteversionof the womb is extremely 
simple ; if the bladder be empty, and a sudden expulsive 
force exerted at the same time, it may be easily tilted over 
anteriorly, especially if it be increased in weight from 
thickening of its walls, or its ligaments have been relaxed 
by frequent child-bearing; the process is much assisted, 
also, by accumulations in the rectum. 

Symptoms. — From the size of the uterus after the fourth 
month, it follows that neither of these displacements can 
occur after that period ; but when retroversion has already 
existed for some time, the rectum, the neck of the bladder, 
and the urethra, must be compressed, giving rise to reten- 
tion of the faeces and urine ; the wonlb, also, being con- 
fined within the hollow of the sacrum, as it enlarges, be- 
comes engorged and inflamed. 

The severity of the symptoms depend upon whether 
these displacements take place suddenly or gradually. 
Supposing the womb to be non-gravid, and the cavity of 
the pelvis of the ordinary dimensions, if the displacement 
take place gradually, the patient begins to feel an incon- 
venient sense of pressure within the pelvis ; then the 
groins, the loins, and thighs are affected little by little with 
dragging pains, which become more and more annoying. 
To these symptoms, there is always added a sense of pres- 
sure or weight at the bladder and rectum, giving rise to 
frequent desire to urinate and go to stool. During the 
flow of the urine, the jet is soon checked or suddenly ar- 



RETROVERSION AND ANTEVERSION SYMPTOMS. 209 

rested, and as the displacement always increases in pro- 
portion to the efforts made to expel the urine and fasces, 
the symptoms are greatly augmented in intensity by those 
attempts. At length, a complete suppression of urine and 
stool is produced. In cases where the size of the womb 
is augmented by pregnancy or engorgement of the organ, 
the symptoms are less equivocal, the constipation and sup- 
pression of urine become complete in a very short time ; 
this is most likely to happen between the third and fourth 
months of pregnancy. However, cases are related by 
authors, in which it has taken place at the fifth, and even 
the seventh month. 

It is easy to understand why the displacement of the 
uterus in pregnant women, is more rapid in its progress, 
and followed by severer consequences, than in the unim- 
pregnated. When retroversion happens in a pregnant 
woman, the orifice of the urethra is carried so far behind 
the pubes, that it becomes difficult to find the meatus, and 
the urethra is so forcibly pressed against the bone that it 
is often impossible to pass up a catheter, even a flat one. 
The escape of the urine which occasionally takes place 
in jets, is in most cases completely suppressed, so that the 
distention of the bladder has taken place to the extent of 
bursting the organ. 

The rectum, also, is so much compressed that the small- 
est portion of faecal matter cannot escape through the in- 
testine ; and the patient is unable to receive enemata. 
Coincidentally with these symptoms, there is found a pain- 
ful tumefaction of the external genitals; and in perform- 
ing the touch per vaginam, the womb is found higher up 
than usual, the anterior wall, of the vagina being very 
tense, while the posterior one is relaxed, and even thrown 
into folds. 

The size of the womb continuing to increase with the 
progress of the pregnancy, it is soon attacked with inflam- 
mation ; the organ being now locked between the sacrum 
and pubis is so powerfully compressed, in some instances, 
that after death it cannot be extricated without dividing the 
pubis. In these cases, the inflammation extends along the 
peritoneum to the bladder, and death has followed either 
from these extensive inflammations, or from the mpture of 

J* 



210 RETROVERSION AND ANTE VERSION TREATMENT. 

the uterus itself, or the giving way of the bladder. In 
rare cases, however, even where the patient has been 
abandoned to nature alone, the womb has spontaneously 
reposited itself, all the symptoms disappearing, and preg- 
nancy has gone on to its full term. 

Retroversion and anteversion are to be distinguished 
from other affections of these parts by the characteristic 
symptoms before named, retention of urine, and of the fe- 
ces. They are to be distinguished from each other, upon 
examination, by the position of che mouth of the uterus ; 
in the former, it will be anteriorly ; in the latter, it will 
be posteriorly. Sometimes, the diagnosis is attended with 
difficulty, and the greatest care and precision is necessary 
in analysing all the symptoms. 

Treatment.— -When the case of displacement is one of 
long standing, before attempting the reposition, we should 
endeavor to remove the inflammatory symptoms by means, 
when it is indicated, of general and local blood-letting ; 
by hip-bathing ; fomentations ; and mucilaginous injec- 
tions. By the judicious employment of antiphlogistics, 
we are often enabled to effect the reduction of cases, in 
which all preceding attempts had failed. 

As preliminary to the reposition, we should evacuate 
the rectum and bladcler, when it is possible to do this ; 
enemata and supposatories should be resorted to for the 
former purpose, and the catheter for the latter ; the flat 
catheter, under these circumstances, is preferable. An- 
other mode should be tried, viz : by raising up the mouth 
of the uterus. After these means having been success- 
fully applied, the organ has in many cases resumed its 
natural position ; and particularly after the evacuation of 
the contents of the uterus. Some authors have recom- 
mended, when these means fail, for relieving the bladder, 
that it should be punctured below the pubes. 

To reduce the womb, the patient should lie upon the back 
with the thighs at right angles with the body, so as to relax 
the abdominal muscles. An attempt should then be made 
to restore the mouth of the uterus, with one or two fingers 
bent into a hook shape, whether it be anteriorly or poste- 
riorly. If this measure fail, let two fingers of one hand 
be carried into the rectum, in order to push up the fundus, 



RETROVERSION AND ANTEVERSION TREATMENT 211 

while with one or two fingers of the other hand j assed 
into the vagina, we try to pull the neck downwards. When 
the mouth of the uterus is high up, there is an advantage 
in the use of the spoon-like hook. When these attempts 
fail, success is often obtained by letting the patient place 
herself upon her knees and elbows, instead of the other 
position, by which the pressure of the abdominal viscera 
is less upon the rectum. ' 

Another plan has been recommended, that of introducing 
tne whole hand into the rectum, and then push up the fun- 
dus of the womb, which should be assisted by a couple of 
fingers within the vagina, to act at the same time upon 
the neck ; or a strong catheter, flattened at its extremity, 
may be passed into the bladder, to be used as a lever in 
depressing the mouth of the uterus. 

Still another means has been recommeded, viz : the in- 
troduction of a bladder into the vagina, and its inflation by 
means of a stomach pump with an air tight piston. 

It is very rare that no one of these means succeeds. 
The general and local irritation that arises from these 
attempts, should be treated by rest, antiphlogistics, and 
opiates. After the reduction has been effected, to prevent 
a relapse, the woman should keep herself in a horizontal- 
posture for several weeks, or months, according to circum- 
stances, to be followed by river or sea bathing and a gene- 
ral system of hygiene. If there be any disposition to a 
return of the retroversion, the patient should place herself 
on her knees and elbows, once or twice a day, and remain 
for an hour or more at a time ; she should avoid constipa- 
tion, and never suffer the accumulation of urine in the 
bladder to any extent. Pessaries have, also, been recom- 
mended, particularly in ante version. 

Lastly, when attempts at reduction fail in pregnant 
women, it has been recommended to pass a sound through 
the mouth of the uterus, (if possible,) for the purpose of 
inducing abortion ; this is sometimes the last hope of safety 
for the female. When the sound cannot be introduced, a 
trocar may be plunged into the uterus, through the vagina or 
rectum, so as to discharge the waters of the ovum, and thus 
excite abortion. This operation has been performed with 
success at the sixth month, thus saving the life of the mother. 



CHAPTER VI. 

OTHER DISPLACEMENTS OF THE UTERUS, AND OVARIA, OF THE 
BLADDER AND URETHSA, OF THE VAGINA, AND OF THE 
RECTUM CAUSES SYMPTOMS AND TREATMENT. 

Some authors have noticed other displacements, of which 
we shall speak but briefly, as they are mostly of rare oc- 
curence, and often connected with those already described. 

RETROFLEXION AND ANTEFLEXION OR CURVATURE OF THE 
UTERUS. 

These have hitherto attracted but little attention from 
either writers or practitioners of medicine, on account of 
their having been confounded with other displacements. 

Where the curvature is a retroflexion, the neck retains 
its natural position, while the fundus of the uterus is turn- 
ed backwards into the hollow of the sacrum, like unto 
what occurs in retroversion. In anteflexion, the fundus is 
inclined forwards, behind the symphysis pubis, similar to 
what happens in anteversion; but the neck, as in the for- 
mer case, retains its natural position. Sometimes the body 
and neck are directed towards the same point, while the 
fundus preserves its natural situation. 

Curvature of the womb is said to be sometimes congeni- 
tal, when one side of the organ is more completely develop- 
ed than the other. But the general causes, symptoms and 
treatment, differ very little from those of retroversion and 
anteversion. While, on the one hand, sterility may depend 
upon this condition, so a pregnancy, on the other hand, 
may bring about a speedy and permanent cure. As soon 
as the delivery is completed, to prevent a relapse, we should 
hasten to procure a perfect contraction of the womb, now 
restored to its natural position, by means of frictions over 
the organ, and by preventing too great an accumulation of 



OTHER DISPLACEMENTS OBLIQUITY. 213 

the uterine and feces. The woman should lie with the 
pelvis higher than the shoulders. 

INCLINATION AND OBLIQUITY OF THE UTERUS. 

By inclination, is meant where the womb leans in any 
direction ; when it inclines backwards or forwards, it may 
be regarded as the first stage of retroversion or antever- 
sion. When it leans to one side, it is a lateroversion, and 
in such a state, the neck of the womb, which rises higher 
than its natural level, inclines its orifice towards one of the 
sides of the vagina, and the patient has in various degrees 
the symptoms of anteversion. When the inclinations occur 
during pregnancy, they are known as obliquity of the 
womb ; they can only take place to the sides and the front, 
distinguished into right lateral, left lateral, and anterior 
obliquity; a posterior obliquity cannot occur in a well- 
formed woman. 

Obliquities may be ascertained to exist by the projec- 
tions, and resistance of the neck of the uterus against the 
abdominal walls. In the anterior obliquity, the fundus is 
directed forwards, and the mouth of the uterus against the 
sacrum. The inclination increases with successive preg- 
nancies ; in some women it is so great, that the abdomen 
falls down over the external genital organs, sometimes 
covering the thighs. It is the one most frequently met 
with, and is caused by relaxation from de'bility of the abdo- 
minal walls ; deformity of the spinal column ; the accu- 
mulation of feces in the colon ; and, finally, by any thing 
capable of inclining the womb fprwards. 

The lateral obliquity forms a prominence at one side of 
the abdomen, the mouth of the uterus being directed to- 
wards the opposite side. The right lateral obliquity is 
much more frequent than the left, and besides the faulty 
direction of the pelvis has been assigned to a variety of 
causes, such as shortness of one of the uterine ligaments ; 
the habit of sleeping always on one side, particularly the 
right one ; and, finally, the existence of a tumor in the 
abdomen or one of the ovaries. 

While the inclinations of the uterus thai take place in 
the unimpregnated stute are of but little consequence, 
10* 



214 OTHER DISPLACEMENTS ELEVATION, ETC. 

those that occur during pregnancy are of importance, as 
they are a prominent cause of difficult parturition. Cer- 
tain inconveniences during gestation may be remedied by 
means of a suspensory bandage to the abdomen. Asa 
measure for obviating barrenness, which might arise from 
a continued obliquity of the uterus, the female should lie 
on the side opposed to the inclination of the neck, durante 
coitu ; and the same precaution should be taken during the 
conduct of a labor. When this is insufficient its reduc- 
tion should be attempted as directed for retroversion and 
anteversion. 

ELEVATION OF THE UTERUS. 

This sometimes takes place to such an extent, that the 
mouth becomes almost inaccessible to the touch, and its pos- 
terior surface wholly so from the rectum. This condition, 
which is rare in the unimpregnated state, may arise from 
an insufficiency of the ligaments, abscess of the ligaments, 
dropsy of the ovaria, extra uterine pregnancy, retrover- 
sion and anteversion, and hydatids or other foreign bodies 
of the uterus. It is, also, the normal effect of pregnancy 
from the fourth to the eighth month. Of course it requires 
no treatment excepting that which is applicable to the dis- 
orders of which it is a symptom. When the elevated state 
of the uterus is a permanent one, it may act as a cause of 
barrenness. 

ABNORMAL IMMOBILITY OF THE UTERUS. 

This, in addition to the obstruction it causes to the pro- 
per dilatation of the bladder and rectum, prevents the rising 
of the womb from the cavity of the pelvis during pregnancy. 
Among the causes, may be mentioned adhesions that follow 
attacks of peritonitis, and inflammation of neighboring or- 
gans, which is the principal one. Tt has been remarked 
that scrofulous women, and those of a lymphatic tempera- 
ment, those girls who abandon themselves to habits of mas- 
turbation, and those who are subject to constipation, are 
more liable than others to unnatural adhesions. 



OTHER DISPLACEMENTS IMMOBILITY HERNIA. 215 

Although sterility, that is often caused by adhesions of 
the Fallopian tubes, is to be regarded as a misfortune, 
conception, in such a condition, is a vastly more serious 
one, since it may give rise to the most important symptoms 
by originating a new inflammation, caused by stretching 
of the ligaments of the expanding womb, as it continues to 
rise higher and higher during the pregnancy. This 
gives the woman violent pain, and dragging in the pelvis, 
and a feeling of lassitude in the thighs. Abscesses 
often form in the vagina and rectum, and in most cases, 
the death of the patient, which is inevitable, is preceded 
by abortion, which may be expected about the third or 
fourth month, upon some attack of violent uterine inflam- 
mation, or profuse hemorrhage. (Colombat.) 

Similar accidental causes may, also, produce adhesions 
during pregnancy,, when the womb is very high up in the 
abdomen, sometimes giving rise, at parturition, to the most 
lamentable results, on account of the laceration of the 
adhesions. 

HERNIA OF THE UTERUS. 

This is a very rare affection. The principal signs of 
its existence are the following : the vagina is stretched, 
and curved towards one of the groins ; the mouth of the 
uterus, which is very high up in the pelvis, is pointed 
towards the sacrum, or disappears by having been lodged 
within the hernial tumor. The tumor is hard, form round- 
ish, and is very little reducible. There are three kinds 
of this affection : called Inguinal, when the tumor makes 
its appearance in the groin ; Crural, when it appears 
down on the thigh ; and Ventral, when it takes place in 
the graved uterus, through an accidental separation of the 
abdominal muscles. 

The causes may be attributed to weakness or relaxation 
of the ligaments of the womb, and of the abdominal muscles; 
to a violent blow, or contusion, etc. The reduction, which 
should be promptly attempted, with great care, cannot be 
effected, except the hernia be a recent one, or without ad- 
hesions, and of small size. A relapse should be prevent 



216 OTHER DISPLACEMENTS — OF THE OVARIA. 

ed, after the reduction, by a large compress, supported by 
a bandage, or a common truss. 

HERNIA AND DISPLACEMENT OF THE OVARIA. 

These sometimes occur, though the former is extreme- 
ly rare ; notwithstanding, six kinds have been described 
by authors, according to the situation of the protrusion : 

1. The Inguinal, when the tumor appears in the groin. 

2. The Crural, when it appears upon the thigh. 3. The 
Ischiatic, when it appears near the loins. 4. The Umbili- 
cal, when the protrusion takes place at the navel. 5. The 
Ventral, when it occurs through the abdominal muscles. 
6. The Vaginal, or vagino- rectal, when it takes place in- 
to those organs. Cases have been met with on one side 
alone, and on both sides at the same time. 

The causes are, the predisposing, and exciting. The 
former are dropsy of the abdomen ; sudden emaciation ; 
immoderate use of warm relaxing drinks; and various 
displacements of the womb. The exciting causes of ova- 
rian hernia are, circular compression just above the hips, 
either by badly constructed corsets, or a belt ; wounds and 
abscesses of those regions. In infancy, it may arise from 
the careless application of bandages for the support of the 
navel ; loud crying, continued for a long time, etc. 

The symptoms are about the same as those connected 
with hernia of the uterus ; the most distinctive sign is, the 
correspondence of motions impressed upon the uterus, by 
the finger introduced into the vagina or rectum, with those 
which are felt in the tumor itself, by the patient or practi- 
tioner. It is probable that assistance might be derived 
from the monthly increase of the tumor, if observed at the 
menstrual period. 

Treatment. — An attempt should be made as soon as 
possible to reduce the hernia, though it will often fail. If 
there be symptoms of strangulation, recourse must be had 
to the operation for strangulated hernia ; after the strangu- 
lation is relieved, if compatible with gentle pressure, the 
ovary should be returned into the abdomen — otherwise, a 
compress and bandage need only be applied, without inter- 
fering with the displacement. 






OTHER DISPLACEMENTS OF THE BLADDER. 217 

The displacements to which the ovaria are obnoxious, 
are mostly connected with those of the uterus, and con- 
sequently surpassed by a greater evil ; the more serious 
ones are congenital. 

displacement of the bladder. 

This may occur in various directions ; its protrusion in- 
to the vagina and external labia, will only be noticed here, 
its other displacements not being peculiar to females. By 
referring to Fig. 2, Book I., and observing the connection 
of the vagina and bladder, it will be easy to understand 
the mechanism of hernia of the bladder into the vagina ; 
the urinary sac being pushed against the anterior wall of 
the vagina by a sudden descent of the diaphragm and vio- 
lent contraction of the abdominal muscles, gives rise to a 
fluctuating tumor, that projects within the vagina, or even 
appears at the external labia. 

The 'predisposing causes are, too large a pelvis ; nu- 
merous pregnancies ; a lymphatic temperament ; an erect 
position too frequent and too long continued ; too violent 
exertion of the muscular powers ; leucorrhea ; retention of 
Urine, and the habit of discharging it too seldom ; abusus 
coitus; an abuse of warm bathing; foot-warmers; tight 
lacing, and the use of busks; general debility; and a pe- 
culiar conformation. The principal exciting causes are, 
parturition ; violent exertions ; tight lacing ; coughing, 
vomiting, violent dancing, etc. It is more common in 
women who have borne children. 

It is known by a tumor presenting itself either within 
the canal of the vagina, or outside of the orifice of the 
vulva. The tumor is blueish, rounded with a polished 
surface when the bladder is distended; otherwise, it is 
uneven, wrinkled and soft. In the former case, it is fluc- 
tuating, and disappears upon pressure. Long standing, 
and violent exercise increases its size, while rest diminish- 
es it. This affection produces difficult and painful mictu- 
rition, and sometimes a tense and enlarged abdomen ; 
sleeplessness and dragging of the stomach, etc. It is fre- 
quently complicated with various inflammations and dis- 
placements of the uterus. When it occurs in a pregnant 



218 OTHER DISPLACEMENTS URETHRA BOWELS. 

woman, it may become so large as to obstruct the passage 
of the foetus. 

Treatment. — After the employment of antiphlogistics, 
if indicated, there presents two indications : to reduce, the 
tumor, and prevent future displacement. When the her- 
nia is small it may be easily restrained by means of a 
sponge cut into a cylindrical shape, or a sachet of fine 
linen ; the former to be impregnated with some astringent 
solution, and the latter filled with oak bark, soaked also in 
some astringent solution, and retained in place by means of 
a bandage. When the tumor is large, the treatment should 
be commenced by the introduction of the catheter — a male 
catheter; if this be not successful, and particularly if the 
patient be in labor, it will be necessary to plunge a trocar 
into the tumor ; when the urine is discharged a catheter 
may be left in the bladder. We should remark that upon 
first using the catheter without success, the tumor must 
be compressed, so as to compel the urine to flow towards 
the open end of the instrument. 

PROLAPSUS OF THE MUCOUS MEMBRANE OF THE URETHRA. 

This is a very rare disorder, which it is only necessary 
to notice. It is owing to a relaxed and thickened state of 
this membrane, and is known by a small redish tumor 
projecting from the orifice of the meatus urinarius. 

DISPLACEMENT OF THE INTESTINES INTO THE VAGINA. 

This sometimes takes place. The predisposing causes 
are partly the same as those of other hernias, repeated preg- 
nancy and delivery, etc. The exciting causes are, also, 
about the same, and may act in a slow and gradual man- 
ner : they are, falls, violent efforts of any kind, at stool, etc. 

This affection exhibits all the general characters of the 
other kinds of hernia. The tumor, which is not trouble- 
some unless very large, is of a soft consistence, and par- 
tially or wholly disappears when the patient lies down. 
Upon examination, the mouth of the uterus is found free 
and in its natural position ; this will distinguish it from 
most other tumors of the vagina. 



OTHER DISPLACEMENTS OF THE VAGINA. 219 

In the treatment, the reduction must be effected if 
possible. The rectum should be evacuated with injections, 
and the woman placed with the legs drawn up, and the 
pelvis elevated. When successful, the hernia should be 
kept reduced, by a cylindrical pessary. If strangulation 
take place, it has been recommended to cut down upon the 
tumor and dilate the opening. Sometimes the intestine 
finds its way down into the labia, when the management 
is similar. — 



prolapsus of the vagina. 

By this is meant an inversion of the internal lining 
membrane of the organ. It is divided into complete and 
incomplete ; in the former, the tumor projects more or less 
beyond the vulva, while in the latter case, it merely ap- 
pears within the mouth of the vagina. 

The predisposing causes are, a lymphatic temperament ; 
chronic leucorrhea ; frequent child-bearing or abortion ; 
the abuse of hot-bathing, and of warm, relaxing drinks ; 
bad nutrition and all the causes of a debilitated body. 
Among the direct causes, should be enumerated abusus 
coitus; masturbation; injury from the child's head and 
instruments during labor ; external violence ; violent* 
efforts of every kind ; leaping, laughing, vomiting, etc. 

Symptoms. — In a partial prolapsus, the tumor is round- 
ed, double, or forms a circular cushion, varying accord- 
ing as the descent implicates both the anterior and posterior 
walls, or extends to the whole surface of the tube. There 
is a feeling of weight and uneasiness about the vagina 
and fundament; and dragging sensations in the lumbar 
region. When the falling is complete, there is a puru- 
lent discharge, obstinate constipation, and stranguary of 
urine. The action of the urine upon the surface of the 
tumor, and friction in walking, often produce painful in- 
flammation and excoriations. 

This affection is very troublesome, and may become 
even dangerous during labor ; though the prognosis, gene- 
rally, is not bad. 

Treatment. — This consists in incomplete prolapsus, in 
the use of antiphlogistics, local fomentations, and poultices, 



220 OTHER DISPLACEMENTS VAGINA RECTUM. 

to be continued till the inflammatory symptoms are over- 
come ; then, tonics, if the constitution require them, and 
astringent lotions and injections. Recourse may, also, be 
had to counter irritation to the loins with advantage. 

In complete falling, after a preliminary antiphlogistic 
treatment, the reduction should be effected as soon as pos- 
sible; then, should be employed tonics internally, and 
astringent lotions and injections, as above directed ; also, 
the introduction of sponges, impregnated with astringent 
solutions, or by sachets filled with proper ingredients. It 
is said that pessaries, also, may be used with advantage. 
A well regulated system of hygiene, with tonics and mine- 
ral waters, should be put in requisition for the restoration 
of the patient. 

When the disorder is of long standing and the tumor 
irreducible, its extirpation by means of the scissors and 
knife, has been recommended. 

INVAGINATION OF THE VAGINA. 

This consists in a displacement of the upper part of the 
tube, which, being carried downwards by the womb in a 
prolapsed state, becomes intussuscepted in the lower part 
of the vagina. This disorder is a lesion secondary to, 
and symptomatic of, the prolapse of the uterus, which is 
its direct cause. It is important not to confound this with 
the prolapse merely of the vaginal mucous membrane, last 
treated of. The treatment, of course, is the same as that 
directed for prolapsus of the uterus. 

PROLAPSUS OF THE RECTUM, HEMORRHOIDS, PILES, COSTIVE- 
NESS, CAUSES, SYMPTOMS AND TREATMENT. 

We 'shall include in our description of this affection, 
hemorrhoidal tumors or piles, which often occur in this 
part. There are two divisions of prolapsus of the rectum ; 
the one is the falling down of the rectum proper ; the 
other is a protrusion of the mucous membrane alone. 
Hemorrhoids are certain excrescences or tumors, which 
arise about the anus or inferior part of the rectum. They 
sometimes discharge blood, particularly in straining at 



COSTIVENESS, PILES, ETC. CAUSES. 221 

stool, when they are commonly known as bleeding piles ; 
but when there is no discharge, they are called blind piles. 
They are often distinguished as external and internal, 
according as they appear externally or not. Both of these 
affections (for they may be regarded as distinct ones) often 
run into each other, being produced by about the same 
causes, operating on different constitutions, or on the same 
constitutions at different periods of life. Prolapsus is seen 
most. commonly in infancy and old age ; while piles occur 
most often at a middle period of life, and are more fre- 
quent in women than in men. 

Causes. — These are predisposing and exciting. The 
former, are a sedentary and luxurious life, producing 
general plethora and acostive habit ; habitual constipa- 
tion ; drastic purgatives ; frequent pregnancies and diffi- 
cult labors ; obstructions in the liver, or venous circula- 
tion ; a lymphatic temperament ; masturbation, and gen- 
eral debility from any cause. The exciting causes, are 
the accumulation of faeces in the colon and rectum ; thd 
determination of blood to the rectum, from the operation ol 
powerful cathartics ; straining at stool from constipation ; 
and long continued dysentery. 

11 When we reflect that, in an ordinary state of health, 
we consume each day an amount of food that we know, 
from occasional intervals in which the bowels perform 
their proper functions, should yield, without effort, five or 
six times the quantity of the customary discharge ; the 
immense consequence of a sufficient daily evacuation of 
the bowels is too plain, for us to view its constant deficiency 
without alarm. It is true, we observe many persons who 
i seem to enjoy a pretty fair state of health, who never have, 
more than two or three evacuations a week ; yet a criti- 
cal investigation would show a very different state than 
that of health, in such individuals. A fevered tongue,, 
an aching head, and inability for active bodily or intel- 
lectual effort, is an almost invariable attendant on this 
state ; and its next result will almost to a certainty be, 
either piles, a permanent weakness or falling of the rec- 
tum, or an abscess, and fistulous opening at its side. 

" Anatomy informs us that the length of the intestinal 
tube is nearly six times that of the entire body ; and that 
11 



222 COSTIVENESS, PILES, ETC. CAUSES. 

four-fifths of it is appropriated to the reception, from the 
stomach, of the nutritious parts of the food and the bile ; 
while the lower fifth, ending in the rectum, is designed to 
contain the waste parts, or that which is to be thrown out 
of the body. 

" The general character of our diet, and experience, is 
such as to assure us, that at least one-quarter of the food 
we swallow is excrementitious ; or intended by nature to be 
evacuated from the system. The experience of persons 
who are habitually constipated, proves that no such 
amount, or indeed any approach to it, is ordinarily dis- 
charged. What then becomes of it ? There can be no 
question, that it is re-absorbed into the system ; for there 
are a sufficient, number of absorbents opening into the 
lower intestine to effect this mischief if the bowels remain 
long unmoved. It is unnecessary for us to point out the 
injurious effect of this poisoning of the blood, with a sub- 
stance so different from that pure fluid found in the upper 
tract of the intestines. 

" It is not wonderful, that designing and knavish indi- 
viduals, should avail themselves of the indolence of that 
half enlightened and physic-consuming class of society ; 
those who, having a mere suspicion of the truths they occa- 
sionally hear from physicians, and from partial observa- 
tion of their own systems, dare not entirely neglect this 
most important function, but console themselves by taking 
enormous quantities of quack pills. These are all made 
of stimulating substances, which act by forcing the intes- 
tines to throw out from their surfaces so large a quantity 
of the serum, or watery part of the blood, as to liquefy the 
hard contents of the bowels. By the excessive irritation 
they cause the whole nervous system of the bowels, they 
force them to contract, and throw off their contents, leav- 
ing the whole tract in a partial, and eventually in a state 
of permanent inactivity." 

Symptoms. — 'First, of prolapsus of the rectum : the 
slightest degree is indicated by a sense of bearing down and 
smarting, especially when at stool. After the evacuation 
of the rectum has been effected, the protruded portion, 
either returns itself, or with very slight pressure. If, 
however, the affection be neglected, the protrusion becomes 



COSTINENESS, PILES, ETC. — TREATMENT. 223 

greater and greater — from one to two, and even six or ten 
inches — when it is not easily replaced. The tumor is 
constantly exposed to the air, and friction from the clothes 
and sitting, by which it becomes inflamed and ulcerated, 
and often fungous and varicose, exhaling blood and an 
offensive matter. In all cases the pain is more severe 
during defecation, and while standing ; the protruded 
membrane is of a dark red color, and sometimes almost 
black. 

The symptoms of hemorrhoids are, first, a sense of full- 
ness, itching, throbbing, heat, tenderness, and dull pain, 
about the anus ; then, a mucous or sero-mucous discharge, 
and hemorrhage. The small tumors, when first protruded 
have but little sensibility ; but when inflamed or strangulat- 
ed, become exquisitely tender. They vary in size from a 
pea to a pigeon's egg ; when small they may be felt thickly 
studding the rectum as far as the finger can reach. Some- 
times a single swelling only projects, resembling either a 
red currant, or a small purple grape ; these tumors vary 
much in size and number. They are, generally, simply 
varicose or enlarged veins, which often bleed very pro- 
fusely, and are much aggravated in character by the 
straining at stool, attendant upon constipation, which is 
most often the cause and accompaniment of this disorder. 

Treatment. — First, of falling of the rectum : the 
patient being placed on the back, gentle pressure should 
be applied to the tumor, by means of the thumbs, previ- 
ously dipped in oil ; or the patient may be placed on the 
face, the thighs separated and the nates pressed together. 
Sometimes it is necessary to introduce (previously well 
oiled) the fore finger into the rectum to remove the stric- 
ture. In children, where the irritation is kept up by diar- 
rhoea, from worms or other cause, those affections must be 
removed, and the bowels should be kept open by the mild- 
est laxatives, or by enemata. A recurrence of the disor- 
der may be guarded against by the use of astringent in- 
jections and fomentations, of a decoction of oak bark, a 
solution of alum, etc., and the application of an appro- 
priate system of hygiene. When there is considerable 
swelling and inflammation of the protruded part, as pre- 
liminary to the attempt at reduction, leeches, cold, poulti- 



224 COSTIVENESS, PILES, ERC. HYGIENIC TREATMENT. 

ces, etc., according to circumstances, may be applied with 
great advantage. When all means fail, it may be neces- 
sary for the surgeon to remove the protruded portion by 
the knife. 

The treatment of hemorrhoids or piles, is divided in- 
to the medical, surgical, and the hygienic. 

When the loss of blood is considerable, cold water, or 
ice, and astringents, as a solution of alum, sulphate of 
zinc, iodide of iron, or creosote, should be resorted to; or 
continued pressure may be made for the same purpose. 
Internal astringents, joined with opium, if there be- much 
pain, will, also, be found useful. Great care must be 
taken, however, to guard against constipation ; for this 
purpose, mild laxatives are to be used, as sulphur in com- 
bination with cream tartar, castor oil with oil of turpen- 
tine, manna and senna, with an appropriate diet, which will 
soon be noticed. 

Should the parts be much inflamed, leeches may be ap- 
plied, and lead lotions used ; also, poppy fomentations, 
aqueous solution of opium, etc., especially where there is 
much itching. When there is general fever, the treat- 
ment should be antiphlogistic ; besides a low diet, and clear- 
ing the bowels, Dover's powders and antimonials may be 
given. When the disease is chronic, and without much 
inflammation, great good may be expected from local as- 
tringents and stimulants; such as an ointment of galls 
with opium, and the addition of acetate of lead if there be 
a tendency to inflammation ; decoction of oak bark ; lotions 
of sulphate of zinc and sugar of lead, with extract of hen- 
bane. The balsam copaiba, or some of the turpentines appli- 
ed locally and taken at the same time internally, have been 
found useful. The bowels should always be kept open ; 
rhubarb, either alone or combined with a minute portion* 
of aloes, answers a good purpose. We need not remark 
that all quack pills and other nostrums should be avoided. 
Lastly, when all these means fail, permanent relief can 
only be obtained by extirpation of the tumor or tumors, by 
means of caustic, ligature or the scissors. The nitrate of 
silver, in all cases, first deserves a trial. 

Hygienic treatment. — The painful diseases last con- 
sidered, are most commonly the result, as has been re- 



WHOLESOME AND UNWHOLESOME FOOD. 225 

marked, of constipation ; this is the result of unnatural 
diet and want of exercise ; — so we have at once the origi- 
nal cause of these affections before us, and the means of 
prevention and cure. It was evidently the design of na- 
ture that there should be a daily movement of the bowels; 
where this does not occur, as we have shown, evil conse- 
quences follow. We have so often spoken of hygiene in 
this work that we purpose here to notice only the subject 
of diet, briefly. 

It is a law of the nature of our constitution, that the 
ingestion of innutritions as well as nutritious material, is 
necessary for the health and well being of the same. As 
the intestines require their appropriate stimulant, which is 
the residual portion of our food, if the article taken be 
concentrated by preparation and almost wholly nutriment, 
it is easy to understand, that inactivity and derangement 
of the bowels must be the consequence. Therefore, fine 
flour, rich jellies, etc., saying nothing of the absurd modes 
of cookery, catering to a pampered appetite, in vogue at 
the present day, must be a mighty scourge to the human 
race ! Yea, almost as great an evil as war, pestilence and 
famine ! 

The food of man should have blended with it innutri- 
tions or residual material, no matter what it may be ; it 
is best as nature has fitted, it for us, with as little change 
by cookery as possible. But better would it be for us to 
partake (with our own) of the food of the stall, and even 
saw dust, than to pamper the taste, as is practiced by a 
great portion of refined society. For it has been proved 
by direct experiment, that animals will live and thrive by 
mixing saw dust with the same food, upon which they 
could exist but a short time without it. 

It would be highly impolitic to prescribe a diet for every 
body ; indeed, the proverb, " what is one man's meat," 
etc., here becomes particularly apposite. It is well known 
that different constitutions and different employments re- 
quire a difference in adaptation of the quality and quantity 
of food. Those who labor can take with impunity food 
that would much distress a sedentary individual ; the for- 
mer evidently require more food, that which is more solid 
and nutritious, than the latter. Dr. Warren remarks : 

K 



226 WHOLESOME AND UNWHOLESOME FOOD. 

" Let those who are compelled to sedentary pursuits, sea- 
sonably lay aside one-third of their ordinary food ; and 
they will experience no loss of time in combatting the hor- 
rors of dyspepsia." Even by those who labor, meat should 
be taken moderately, and but once a day ; the sedentary 
generally do not need it. It should be cooked, always 
exposed to the free admission of air. Bread should be 
made of grain in its natural condition, that is, without sepa- 
rating the bran from the flour ; or it may be mixed with 
Indian corn. It should be made properly at home, and 
never purchased of a class of men who are often so un- 
principled as to disregard law and feeling, and tamper with 
the public health, by adulterating it with stale and sour 
flour, as well as with vile and astringent drugs. 

The rule should be, no article of food or drink to be in- 
dulged in, that is known to disagree with the stomach or 
bowels. Food may disagree in various ways : it may re- 
main too long before being digested, when it will occasion 
eructations, a sense of oppression or pain about the stomach, 
palpitation of the heart, dizziness, headache, constipa- 
tion, diarrhoea, nausea, or vomiting. It may become acid, 
giving rise to wind, burning in the stomach, known as 
" heart-burn, " pain, regurgitations of the contents of the 
stomach, oppression, distention of the abdomen, etc. It 
may either produce costiveness, or diarrhoea ; but in what- 
ever manner it disagrees with the individual, it should be 
laid aside, and some other articles substituted. 

For guarding against costiveness, then, nothing is near 
as good as dieting ; though medicine may be necessary 
where obstructions already exist, cathartics should never 
be long continued for the cure of this affection. For this 
purpose, bread made from the unbolted wheat flour, regu- 
larly persevered in, by making it the substitute for all 
other bread, will rarely fail. We may, also, have recourse 
to ripe fruits, which are almost all more or less aperient ; 
a few, however, are astringent and should be rejected. 
Generally, they are more wholesome uncooked, unless the 
cooking consist in plain stewing. We should name toma- 
toes, either raw or stewed, as an article of food well adapted 
for all costive individuals. 

Milk and water are the natural drinks of mankind ; bu 



UTERINE DROPSY. . . 227 

not too much of these, even, should be used. The inges- 
tion of drinks, to a certain extent, seems to be an acquired 
habit ; particularly their use with our food. If mastica- 
tion and insalivation were perfect, they would not be need- 
ed ; for in chewing, carried on moderately, the salivary 
glands are excited to action, and throw out sufficient saliva 
to moisten the food without the use of fluids. Hence, the 
use of tea, coffee, and other fluids with our meals, is in- 
jurious in several ways: 1. by hastening the swallowing 
of food, before well masticated ; 2. by moistening the ali- 
ment with liquid instead of the saliva, which is needed in 
digestion ; 3. by diluting the gastric juice in the stomach, 
which is the essential agent in the digestive process ; it 
thus becomes weakened, and consequently unfitted to ful- 
fill its important purpose. 

We have before sufficiently dwelt upon the injurious 
qualities of tea and coffee ; it may be added, that they are 
decidedly constipating, particularly the former. Let us 
close by adding, that the temperature of our drinks and 
food is another point worthy of attention : very hot and 
very cold things are unfavorable to a healthy action of 
the stomach ; the former, by diminishing the tone of this 
organ, and the latter, by suppressing its secretion. Ice, 
iced water, and ice cream, are objectionable as articles of 
daily food, but are often valuable remedies in the hands 
of the physician. All kinds of stimulating drinks are, 
also, pernicious: 1. by diluting the gastric fluid, as above 
stated ; 2. by overstimulating the stomach. All alco- 
holic drinks have the property of preventing the decompo- 
sition, and, of course, retarding the digestion of food. 



CHAPTER VII. 

UTERINE DROPSY— CAUSES SYMPTOMS AND TREATMENT. 

Uterine dropsy consists essentially in the excessive 
secretion of fluid by the lining membrane of the uterus, 
and its accumulation, in consequence of the obliteration oi 
the canal of the mouth and neck. It also arises in con 



228 UTERINE DROPSY CAUSES SYMPTOMS. 

sequence of ulcerous discharges within the cavity of the 
uterus, which are retained in the same manner. 

It occurs most frequently in married women of middle 
age — also, during pregnancy. When the accumulated 
fluid arises from the lining membrane of the uterus, it is of 
a serous or mucous character ; but where it arises as the 
result of organic disease, or when it has been long retain- 
ed, it is frequently dark-colored and offensive. 

The quantity of the fluid accumulated varies ; most 
generally, when it amounts to more than one or two pints, 
a passage is forced for its discharge. Occasionally, how- 
ever, the uterus becomes distended to an alarming extent ; 
authors mention cases in which from 50 to 18U lbs., have 
been found. 

The* causes of this disorder have been .attributed to 
blows upon the abdomen, but more generally to debility of 
constitution, and a universel dropsical diathesis. 

Symptoms. — After the disease has existed for some time, 
the tumor of the enlarged uterus, may be perceived at the 
lower part of the abdomen ; it is moveable and fluctuat- 
ing and gives a dull sound when percussed. When the 
accumulation becomes large, there is inconvenience from 
its size, with tenderness, and a dull pain in the tumor. 
The menses are almost always suppressed, but leucorrhea 
is sometimes present. There is often sympathetic enlarge- 
ment of the breasts, with occasional secretion of milk. In 
the advanced stage of the disease there is general debility 
of constitution, with loss of appetite, irregular bowels, etc. 

Uterine dropsy is distinguished from pregnancy by the 
absence of quickening and the greater roundness and soft- 
ness of the tumor. It is also distinguished from other 
diseases of these parts by comparing symptoms. If the 
mouth of the uterus be completely closed and the accumu- 
lation continue to increase, death from rupture of the uterus 
will result, unless relief be afforded by art. 

Treatment. — The endeavor should be to evacuate the 
contents of the uterus.. This may sometimes be done by 
inducing coughing, sneezing or vomiting. If this does not 
succeed, if possible, a canula must be passed into the cavity 
of the womb. 

Should the neck be impervious, it must be punctured 



MOLES, HYDATIDS, ETC., OF THE UTERUS. 229 

with a trocar or other suitable instrument ; this operation 
is nut unattended with danger, but there can be but little 
doubt as to its propriety. 

After the evacuation of the uterus, the next object will 
be to produce a change in the secretion of the mucous 
membrane by diuretics, purgatives and alteratives. 
Counter-irritation to the sacrum, and uterine injections of 
mineral waters or astringents will probably be found 
useful. The general health must by no means be neg- 
lected. A suitable diet, air, and exercise without fatigue, 
will be of great service. 



• CHAPTER VIII. 

MOLES, HYDATIDS, ETC., OF THE UTERUS. 

The term mole has been applied by some authors to a 
variety 'of shapeless masses, discharged from the uterus, 
whether detached polypus, clots of blood or blighted con- 
ceptions. To make the term more significant and intelli- 
gible we shall confine it to the latter, which we shall 
divide into three species — excluding from the list polypus, to 
be described elsewhere — 1. False conceptions. 2. Fleshy 
Moles. 3. Hydatids. The two latter species may be 
• regarded as mere varieties or transformations of the first. 

1. In blighted conception the vitality of the Jwtus, 
having been destroyed, it remains as a foreign substance. 
In most of these cases, but slight traces of the foetus are 
to be found, as' a portion of the umbilical cord — the remain- 
der having been dissolved in the liquor amnii. 

The whole mass is observed to be a good deal changed 
in size and form, as well as structure, by the effusion of 
blood and formation of coagula. 

The causes are very slight which may destroy the life 
of the foetus at an early period of its existence : such as 
mental and bodily shocks and irregularities even of the 
nervous and circulatory systems. It is seldom retained in 
the womb more than two or three months, but if not ex- 
pelled it becomes transformed into the fleshy mole. 



230 MOLES, HYDATIDS, ETC., OF THE UTERUS. 

2* The fleshy mole is a degeneration of the formei 
species ; it has become more shapeless and of a denser 
texture ; the oa^gnla seems to have become gradually- 
organized. These moles are found in solid masses, and 
with a central cavity, in which there remains some of the 
liquor amnii. The larger ones, which are the solid moles, 
are about the size of the two fists. 

3. Hydatids, or the vesicular mole. The development 
of these hydatids have been accurately traced. They are 
found in small numbers growing upon the outside of the 
ovum and placenta, as yet unchanged in form. They are 
observed gradually to encroach until the figure Ot the 
foetus is altogether obliterated. 

The hydatid varies in size, from a pin's head to a grape ; 
and in shape, from an oval to a round and elongated form. 
The quantity of these contained in the uterus varies ; some- 
times reaching to a large amount and resembling a cluster 
of grapes upon the stern. 

These hydatids were formerly believed to be animals, 
possessed of an independent existence ; but this supposi- 
tion is abandoned by all recent writers. They generally 
remain longer in the uterus before their expulsion takes 
place, than the other species ; and they have been known 
to be five or six years in accumulating. 

There has been a question which involves an important 
point in legal medicine, whether moles are the result of 
conception? After excluding coagula and polypus from 
the list, among all modern authors, there is scarcely a 
dissenting voice from the affirmative. Dr. Churchill re- 
marks : " We may, therefore, conclude that moles, properly 
so called, whether blighted conceptions, fleshy moles, or 
hydatids, are truly consequent upon sexual intercourse 
and impregnation ; but in the practical application of this 
judgment to forensic medicine, we must not forget that this 
does not imply criminality or impropriety in every case ; 
as for instance, a widow may have conceived during the 
lifetime of her husband, and the death of the embryo not 
having been followed by the expulsion of the ovum, it may 
remain in utero until after the death of the husband, and 
then be discharged without the slightest suspicion attach- 
ing itself to her conduct." 



FIBROUS TUMORS OF THE UTERUS. 231 

The symptoms, for the first few months, exactly resemble 
those of pregnancy. The menses are suppressed, the ab- 
domen enlarges, the breasts increase, and secrete a milky 
fluid, etc. But it may be distinguished by the absence o! 
foetal movement, pulsation of the foetal heart, and the con- 
tinuance of the abdominal swelling beyond the period of 
utero- gestation. The health of the patient, generally 
speaking, does not suffer more disturbance than is depend- 
ent upon pregnancy. 

Treatment.- — The womb, sooner or later, makes an 
effort to expel its contents, when the usual phenomena of 
labor, or abortion occurs ; there is a preliminary mucous 
discharge from the vagina, labor pains, etc., when the mole 
is expelled. 

The process will not require interference, unless there 
be considerable hemorrhage, which may be arrested by 
applying cold, or plugging the vagina, as directed in the 
chapter on menorrhagia. Should it be deemed necessary, 
the ergot of rye may be given, in scruple doses ; or, should 
the uterine distention be equal to pregnancy at the seventh^ 
month, the hand may be introduced and the mole brought 
away. 

Subsequently, the patient should be managed as after 
ordinary labor, but with special reference to the flooding. 



CHAPTER IX. 

FIBROUS TUMORS OF THE UTERUS AND OVARIA NATURE 

CAUSES SYMPTOMS, AND TREATMENT. 

This appellation is applied to a species of fleshy tumor,, 
which does not ulcerate, nor is it malignant, and is of in- 
convenience only from its mechanical effects. Such tu- 
mors consist of a mass of irregular fibres, often collected 
into a number of separate lobules, which are connected 
together by loose cellular tissue. 

These tumors have been divided, according to their mode 
of attachment to the uterine structure, into those which 
have a pedicle, and those which have not ; the pediculated 



232 FIBROUS. TUMORS OF THE UTERUS— CAUSES. 

tumor is the proper polypus and will form the subject of 
the next chapter. The non~pediculated tumor is the subject 
of this chapter. 

Fibrous tumors may either be imbedded in the uterine 
structure, or formed immediately beneath the serous or 
mucous membranes ; in the latter case, they project ex- 
ternally or internally, causing an alteration in the figure, 
and diminution of the capacity of the womb. These tu- 
mors vary in number and size. Several of them are often 
found in different parts of the uterus, excepting the neck, 
where they are rarely seen ; they are found of all sizes, 
from that of a pea to that of a man's head; in rare in- 
stances, they have been known to weigh as much as thirty 
or forty pounds. They are generally composed of a white 
or gray fibrous tissue, surrounded with a celluiar struc- 
ture ; here and there may be seen portions softer and 
harder than the general mass, and sometimes interspersed 
with calcareous matter, consisting of phosphate and carbo- 
nate of lime, with animal matter. %Their form is usually 
more or less globular, but they may he very irregular ; 
the color, when cut into, may be dull, with numerous 
white lines, or resplendent. 

Causes. — Various theories have been proposed to ex- 
plain the formation of these -tumors ; by some, they have 
been regarded merely as lesions of nutrition, by others, 
as a species of concretion around a nucleus of blood or 
pus. Among the predisposing causes have been men- 
tioned a lymphatic or scrofulous temperament, chronic * 
leucorrhea, ct, ibacy, barrenness, abortion, certain seden- 
tary employments, as those of the cook, seamstress, etc. 
Period of life seems to have an influence upon their de- 
velopment ; the age from thirty to forty, and that from 
.forty to fifty years, are the terms in which they are most 
frequently met with. 

The exciting causes are equally obscure. It may, as 
a general rule, be correct to say that the essential cause 
consists in a certain mode of irritation, whose persistence, 
at a given point of the uterus most affected, determines at 
that point a new mode of nutrition and vitality, the precise 
nature of which, it will be forever impossible to explain, 
but which may to a certain extent, be compared with the 



FIBROUS TUMORS OF THE UTERUS TREATMENT. 233 

ligneous excressence arising from punctures made by. the 
Cynips Gallce, on the oak twigs that produce the nut-gall ; 
such as punctures, fissures, excoriations, abusus coitus, 
and injury during labor. (Colombat.) 

Symptoms. — In most cases, the patient complains of a 
weight in the pelvis, bearing down, and aching in the 
loins. From the pressure of the tumor upon the bladder 
and rectum, the evacuation of their contents may be im- 
peded, and a frequent desire produced to void the urine 
and faeces ; cramps in the legs and thighs may occur, or 
dropsy of the lower extremities. If the tumor be large 
it may give rise to retroversion, or other displacements of 
the uterus. Menstruation is often interfered with; it may 
become suppressed, or excessive ; the latter is rare. There 
is sometimes a mucous discharge, but the tumor is rarely 
ulcerated. 

Conception may take place, but abortion is extremely 
liable to occur at the third or fourth month ; if pregnancy 
go on to the full period, at parturition .there is danger of 
flooding. 

In some cases there is sympathy of the breasts, which 
become swollen. There are, sometimes, constitutional dis- 
turbances, which are secondary to those local ones men- 
tioned. If the patient be thin, the tumor if sufficiently 
large, may be detected through the walls of the abdomen, 
or by a vaginal examination ; the two modes conjoined is 
better, or, by the rectum, since by depressing the tumor 
• felt in the abdomen, a shock will be given to the finger in 
the vagina or rectum. The enlargement of these tumors 
is extremely slow : months and even years may elapse, 
with little or no increase of inconvenience. It should be 
remarked that the investing membrane becomes occasion- 
ally ulcerated without participation of the tumor. Fibrous 
tumors are sometimes gradually converted into polypus, 
by a change in their attachment, from various causes. 

The prognosis, in general, is not very unfavorable. 
They may be distinguished from other uterine degenera. 
tions by comparing symptoms. 

Treatment.: — The treatment of fibrous tumors. is little 
more than palliative. It has been supposed that iodine and 
mercury have the effect of reducing them, but the latter 



234 FIBROUS TUMORS OF THE UTERUS — TREATMENT. 

is now scarcely ever used for that purpose. Iodine may 
be resorted to with the hope, in many cases, of checking 
their further development, but little more can be expect- 
ed. It may be used internally in the form of syrup and 
the compound tuiGture ; but the most eligible mode of ex- 
hibiting it, in this condition, is, in form of ointment, exter- 
nally, over the tumor. An excellent ointment is composed 
of five grains of iodine and a drachm of iodide of potash, 
to an ounce of lard ; to be rubbed in, as above, two or 
three times a day. 

The patient should avoid as much as possible, the deter- 
mination of blood to the uterus, and when inflammation 
occurs, it may be subdued as directed in the chapter on 
Inflammation of the Uterus ; any hemorrhage that may 
arise must be treated as directed under Menorrhagia. 
Other symptoms must be met as they arise ; — in particu- 
lar, the evacuation of the rectum and bladder must be 
assisted, if necessary, by art. Cupping the loins and leeches 
to the vulva, are useful, according to circumstances. 

These tumors have occasionally been spontaneously ab- 
sorbed, and oftener, separated from their connections by 
ulceration, and discharged by the vagina. Operations, 
imitating these efforts of nature, are resorted to for the 
relief of the patient, which will be described under Polypus 
of the Uterus. It is surprising how common these morbid 
growths are, and how rarely they are productive of bad 
consequences ; as has already been remarked, they are of 
inconvenience, principally, from their bulk and weight. 

Fibrous tumors are found attached to, and imbedded in 
the substance of the ovaries, as well as the uterus ; they 
are often coincident in both organs. These tumors are 
identical in structure, are produced by about the same 
causes, give rise to nearly the same symptoms, and the 
treatment, also, is the same with those of the uterus. They 
may be distinguished by an examination per rectum. Com- 
plete relief may sometimes be given by pushing the tumor 
up beyond the brim of the pelvis. 






CHAPTER X. 

POLYPUS OF THE 'UTERUS CAUSES SYMPTOMS, AND TREAT. 

MENT WITH OTHER MORBID COLLECTIONS IN THAT ORGAN. 

The term polypus of the uterus is used to designate a 
class of tumors, of the fleshy kind, which grow from the 
inner surface of this organ, and are attached to it by means 
of a pedicle or neck. These morbid productions do not 
much differ in structure, from those noticed in the preceding 
chapter ; there is, however, a difference of form, situation, 
and in the symptoms resulting. 

Polypus is found attached not only to the body of the 
uterus, but, also, to the funJus, neck and mouth of the 
organ. They vary in shape, size, color, etc. They are 
generally of a pyriform shape, but are often found of an 
oval form. They are found no larger than a pea, and 
then again, of an enormous magnitude. Some are quite 
white, others reddish, and others dark brown ; their surface 
is generally smooth. Sometimes, instead of being attached 
by one stock only, two, and even three, are found. 

Polypus, at the commencement of its growth, is enclosed 
within the cavity of the uterus ; but, as it increases, it 
gradually dilates the neck and mouth, passing insensibly 
through them, and protrudes itself, more or less, completely 
into the, vagina. The expulsive force of the uterus some- 
times detaches the polypus altogether, and entirely ex- 
pels it. 

Sometimes veins are discovered on the surface of these 
tumors, but in general, they are scantily supplied with 
blood vessels ; and as the circulation in them is not very 
active, it is difficult to explain the occurrence of the dan- 
gerous hemorrhages which often take place in them. 

Causes. — These are the same as those mentioned in the 
preceding chapter, as giving rise to fibrous tumors, and to 
them the reader is referred. As polypus has been ob- 
s« rved to occur after abortion and parturition, it has been 



236 POLYPUS OF THE UTERUS SYMPTOMS. 

conjectured that a portion of placenta, or clot of fibrine 
may have been retained, which served as a nucleus for 
organization : undoubtedly some degree of irritation is 
requisite for their production. They occur most frequent- 
ly in those of a lymphatic temperament, and of a sedentary 
life. They are not common before the middle age, but 
attack equally the single and married. 

Symptoms. — At an early stage of the formation of poly- 
pus, the symptoms are extremely obscure ; but when the 
disease is considerably advanced, they assume a distinct 
and formidable character. The mucous secretion is in- 
creased and often becomes purulent, constituting a con- 
stant leucorrheal discharge, which varies much in quantity 
and quality at different periods. This discharge is follow- 
ed, sooner or later, by a mixture of blood from the surface 
of the polypus. This hemorrhagic discharge occurs ir- 
regularly, as to time and quantity, seeming to depend upon 
the determination of blood to the uterus, from any cause ; 
it is the most formidable symptom of the disorder, and is 
often sufficient to reduce the patient to a dangerous con- 
dition. The appetite becomes impaired, the bowels relax- 
ed ; dropsy of the extremities occurs, etc. The blood may 
be discharged in a fluid state, or in clots, some of them 
being accurate moulds of the polypus ; it may, also, be 
retained till it becomes putrid. It would seem that small 
polypi bleed quite as profusely as large ones. These 
symptoms are liable to be mistaken for those of leucorrhea, 
or menorrhagia simply. 

As the polypus increases, the symptoms become aggra- 
vated. Menstruation is very uncertain, as regard^ time 
and quantity. There is weight, dragging sensations, and 
pain in the back and loins; vomiting, with an increase of 
the dyspeptic symptoms ; finally, great debility, and the 
patient may sink under the continued discharge, unless 
the bearing down pains that occur, break the stalk and 
expel -the polypus, which sometimes happens — when the 
symptoms abate. When the tumor is large, there is pres- 
sure on the bladder or rectum, producing dysuria and 
tenesmus. 

The presence of polypus does not prevent conception, 
unless it be quite large, but there is a constant liability to 



POLYPUS OF THE UTERUS TREATMENT. 237 

abortion. When a very large one descends into the cavity 
of the pelvis, it is a serious obstacle to delivery, and re- 
quires instant removal. Polypus has been known to occa- 
sion prolapse and inversion of the womb. We should re- 
mark, that no case of uterine hemorrhage ought to be 
passed over without making a vaginal examination ; the 
tumor may at once be discovered, if it be not retained in 
the uterine cavity, by its being rounded, smooth, and in- 
sensible, and generally pear-shaped ; the stalk most often 
may be traced up to, or through the mouth of the uterus. 
If the polypus still remain in the cavity of the uterus, 
that organ will be enlarged in proportion to the size of the 
tumor. 

Great care should be taken to distinguish polypus from, 
1. pregnancy; 2. vaginal hernia ; 3. hernia of the blad- 
der ; 4. cancer; 5. cauliflower excr essence ; 6. prolapsus 
of the uterus; and 7. inversion of the womb, by diligently 
comparing all the symptoms. 

Treatment. — We are first to determine whether the 
polypus be within reach or not, by a vaginal examination. 
When it is not, and in those cases where the evidences of 
its existence are slight, we must be satisfied-with pallia- 
tive measures, in attending to dangerous symptoms, sup- 
porting the constitution, and assisting the descent of the 
polypus. • 

The hemorrhage must be treated by the horizontal pos- 
ture, cold astringent injections, plugging the vagina, coun- 
ter irritation, astringents with opium internally, etc. 
Nutritious food and tonics should be given, and wine or 
brandy, if necessary, to support the patient. The ergot, 
given .at this period, may be useful in two ways, viz: by 
restraining hemorrhage, and by assisting in expelling the 
tumor. 

But when the polypus is within reach, nothing short of 
removal should be attempted, as that alone will save the 
patient. There are three principal modes of doing this; 
the one should be selected best adapted to the circum- 
stances: 1. By torsion, or twisting it off. 2. By ligature, 
the polypus being allowed to slough off. 3. By excision, 
with the knife. Crushing has been added, that is, by 
breaking the polypus to pieces, either bv forceps or the 
11* 



288 CALCULUS OR STONE. 

fingers, and then extracting it. Cauterization, formerly 
proposed, is now never applied. 

The two plans most often prefered are, by ligature, and 
by excision ; the peculiar advantages of either of which, 
the experienced physician will be able to appreciate in 
particular cases. When the polypus is so large as to be 
wilh difficuly forced through the passages, the free appli- 
cation of belladonna ointment has been recommended ; also, 
the division of the tumor, and even incision of the neck 
of the uterus. 

After the operation of removal, whatever it may be, 
emollient injections should at first be used, to be succeeded 
by slight astringent and tonic ones ; if inflammatory symp- 
toms appear, they should be treated as directed for inflam- 
mation OF THE UTERUS. 

OTHER MORBID DEGENERATIONS OF, AND COLLECTIONS IN, THE 
CAVITY OF THE UTERUS. 

Degenerations and morbid collections, other than those 
mentioned, and of minor importance, sometimes occur in 
the uterus. 

CALCULUS OR STONE. 

Althouh this is a rare affection, a sufficient number of 
cases are on record to entitle it to notice. M. Louis, an 
eminent French physician, has collected most of the cases 
that have been recorded by authors for the last few centu- 
ries. He mentions one that weighed nine drachms and a 
half; another, which weighed four ounces, but might have 
weighed a pound, had the material not been so porous. 
One of the most curious cases, is that mentioned by Bar- 
tholin, wherein a rough, black calculus weighed four 
pounds; another, equally remarkable, is reported by 
Ruysch, where he removed from the womb forty-two 
stones of different sizes. 

The causes of the formation of uterine stone are some- 
what obscure. Louis supposed that they proceeded from 
the degeneration and aggregation of the morbid secretions 
of the organ, in the same manner as urinary and biliary 






PHYSOMETRA, OR UTERINE TYMPANITES. 239 

stone is formed in the bladder and ducts of the liver; quite 
recently, the more general opinion has obtained, that they 
are produced by the changes undergone by fibrous tumors, 
which have been detached from their place of formation. 
They may, also, arise from fragments of an embryo, or 
mole, and in short, from any foreign body in the womb, 
which may constitute a nucleus for concretion. 

These calculi may exist in the uterus a long time with- 
out giving rise to much inconvenience. The symptoms 
are very obscure ; sometimrs there is a sense of weight 
and dull pain in the back and loins ; sometimes an intoler- 
able itching of the vulva, with discharges from the vagina. 
Sometimes bearing-down pains come on, and the calculus 
is spontaneously discharged ; this may be assisted by 
baths and emollient injections. 

When a calculus gives rise to inconvenient symptoms 
from its size, its extraction should be attempted by long 
narrow forceps made for the purpose. 

OSSEOUS AND CARTILAGINOUS FORMATIONS. 

These occur mostly at an advanced period of life ; 
either from similar causes as the preceding formation, or 
from a degeneration of a part or nearly the whole of the 
coat of the uterine vessels, producing sometimes complete 
obliteration of the mouth of the organ. 

PHYSOMETRA, OR UTERINE TYMPANITES. 

This has been applied to the accumulation of a gaseous 
fluid in the cavity of the womb, which is said to take place 
under different circumstances : it may be a secretion of 
the mucous membrane, or arise from the decomposition of 
a portion of the placenta, a clot, or of some of the lochia. 
This affection is so extremely rare, that many modern 
authors are disposed to doubt its existence. We have some 
remarkable accounts of it from the ancients, who supposed 
that the accumulation might take place to an alarming 
extent ; but they are now regarded as somewhat fabulous. 

It is true, that immediately after delivery, the womb in 
its alternate contractions and expansions may draw up air, 



2 10 CAULIFLOWER EXCRESSENCE OF THE UTERUS. 

which is expelled again with an explosive report from the 
vagina ; and it is probable that gas may be generated from 
decay of a portion of the placenta, or be secreted by the 
lining membrane. But these are of little consequence, as 
long as the mouth of the uterus remains open for its dis- 
charge ; should it by any accident become closed, it is 
easy to conceive how distension of the womb might take 
place. But, as we have already remarked, this occurence 
is so rare that many physicians doubt its ever taking place. 



CHAPTER XI. 

CAULIFLOWER EXCRESSENCE OF THE UTERUS — -NATURE, SYMP- 
TOMS AND TREATMENT. 

The term cauliflower excresscence, has been given 
to a morbid growth, from a part, or the whole, of the cir- 
cumference of the mouth of the uterus ; it is sometimes, 
though rarely, found upon the surface of the uterine cavity. 
It is met with in females of all ages, and all temperaments, 
in the married and unmarried, without regard to habits, or 
residence. (Churchill.) 

„ Its causes are extremely obscure ; it cannot be consid- 
ered the result of injuries, and Dr. Clark thinks that the 
disposition to it is hereditary. 

Symptoms.— The tumor is very vascular, of a bright 
fleshy color, with a smooth or slightly granulated surface, 
upon which are numerous small projections. The struct- 
ure is somewhat firm, and disposed to bleed ; it is covered 
with a delicate membrane, which gives rise to a copious 
watery discharge. This discharge is the first symptom 
noticed by the patient, which sometimes becomes enor- 
mous. Soon, it is observed to be mixed with blood, and 
hemorrhage occurs to an alarming extent, producing all 
the symptoms of constitutional exhaustion. At this period 
bleeding may be produced by slight causes, as coitus, 
defecation, and even an examination ; during the intervals 
the watery discharge goes on as before. The stomach 
and bowels become much disordered, vomiting occurs, 



CAULIFLOWER EXCRESSENCE OF THE UTERUS. 241 

and the patient may die of dropsy, or effusion into some of 
the great cavities of the body. 

An examination per vaginam, reveals the appearance of 
the tumor as above described ; it is insensible and varies 
in size, from that of a strawberry, to that of a bulk suffi- 
cient to fill the whole vagina and protrude at the vulva. 
The tumor, if extirpated, is liable to be reproduced. 

It may be distinguished from polypus by its soft and 
granulated surface, and by its disposition to bleed when 
touched, and by the absence of a pedicle; from cancer, 
by the difference of symptoms, and by its insertion into the 
lip of the mouth of the uterus. 

Treatment. — It is doubtful whether the progress of the 
disease can be arrested, except by excision. We should 
direct a recumbent posture ; an avoidance of determina- 
tions of blood to the uterus ; a mild, unstimulating diet ; 
and an avoidance of mental and sexual excitement. The 
patient should, of course, live absque marito. Derivatives 
to the lumbar region are often useful. We should en- 
deavor to arrest the watery discharge and hemorrhage, by 
cold sponging the loins and vulva, by the douche, and by 
astringent injections ; for this purpose, any of the astringent 
decoctions, or solutions may be used. When the tumor 
fills the vagina, it has been recommended to pour the as- 
tringent lotion into that organ, while the patient is lying 
on her back, with the hips elevated ; or lint, dipped in the 
lotion may be applied. The bowels must be kept free. 

Dr. Churchill has met with complete success, in curing 
this affection, by first removing it with the ligature, and 
then applying strong caustic (muriate of antimony) to the 
spot from whence it was removed. And, if we do not 
succeed in arresting the hemorrhage, by the means above 
mentioned, there is no doubt of the practicability of this 
method, even if the tumor grow again, as it frequently will ; 
for the patient, if left to herself, must certainly very soon 
die. Any one of the ligatures in common use may be 
applied, and when the tumor is separated, astringent in- 
jections must be used, which will check the disposition to 
reproduction. Lastly, we should remark, that amputation 
of the neck of the uterus has been recommended as a 
permanent means of cure for this disorder. 



CHAPTER XII. 

CORRODING ULCER OF THE UTERUS — NATURE — SYMPTOMS 

DIAGNOSIS, AND TREATMENT. 

Corroding ulcer of the neck of the uterus is a malig- 
nant disease, and may extend to the fundus, implicating 
the whole organ, as well as, occasionally, the bladder, 
vagina, and rectum. It commences upon the mucous 
membrane, in the form of a small ulcer, gradually de- 
stroying the uterus, if not arrested, and with it, life. It 
has often been mistaken for cancer, and is doubtless very 
similar to that disease. It attacks females of the lymphatic 
temperament, especially ; rarely appears before the age 
of forty, and most often about the period of the cessation 
of the menses, or soon after. 

Symptoms. — In some cases, this grave disease is preced- 
ed by uneasiness and pain in the pelvis, and by leucorrhea ; 
but in other cases, attention is first directed to it from the 
profuse hemorrhage, which may be mistaken for menorrha- 
gia simply. But upon examination, ulceration of the neck 
is discovered to a greater or less extent; with a rough, granu- 
lar surface, which may be but slightly tender, or very 
painful. The hemorrhage and pain are not continuous, 
but the ulceration continues to spread. 

At this period, during the intervals of bleeding, a thin, 
profuse and offensive discharge takes place from the vagi- 
na. There is now weakness, weight and pain in the back 
and loins ; the patient becomes emaciated ; there is sick- 
ness of stomach, with loss of appetite ; the bowels are 
irregular; the skin becomes dry and sallow, and a low 
fever sets in, with a quick small pulse. The distress of 
the patient is often increased by excoriations of the vulva, 
caused by the acrid discharge. The disease may now 
advance rapidly, and destroy life, or it may continue for 
years without producing that event. 

When the discharges are augmented, all the above 






CORRODING ULCER OF THE UTERUS TREATMENT. 243 

symptoms become aggravated, and the patient ultimately 
sinks from exhaustion, or is carried off by peritonitis, from 
the extension of the ulceration to that membrane. 

There is great similarity of this disease to cancerous 
ulceration; but preceding the latter, there is .extensive 
deposition in and about the uterus, rendering it immova- 
ble ; whereas, in corroding ulcer, no deposition having 
taken place, the uterus can be -moved by gentle pressure. 
By examination per rectum, as well as per vaginam, and 
taking into consideration the above facts, the true nature 
of the malady need not be mistaken. 

The prognosis of this disease is always unfavorable, 
there being but little hope of a permanent cure. 

Treatment. — Should the disease be detected early, 
which is seldom the case, the abstraction of blood from 
the part by leeches has been recommended ; hip-baths may, 
also, be serviceable at this period. Bat if ulceration have 
commenced, we should make applications calculated to 
arrest its progress, and excite a healthy action, although 
there is seldom but little hope of doing either. The appli- 
cations of caustic iodine, nitric acid, deuto-nitrate of mer- 
cury, nitrate of silver, muriate of antimony, etc., have been 
recommended for this purpose by different authors ; those 
first mentioned have been found the most useful. They 
should be applied through the speculum, and followed by 
the use of emollient and opiate injections. 

If these remedies fail of arresting the disease, we must 
rest satisfied with palliating the more distressing symp- 
toms : for this purpose, morphine, opium, hyosciamus, etc., 
may be given to alleviate the pain ; astringent injections 
may be made use of to check the discharges; and mucila- 
ginous, aqueous, and anodyne ones, to cleanse the vagina 
and assist in relieving the pain. Extreme cleanliness 
should be observed by washing the external parts two or 
three times a day, with tepid milk and water ; and the 
bowels must be kept free by mild laxatives or enemata. 
The diet should be nutricious but not stimulating. 

It has been suggested that excision of the neck of the 
uterus is the more appropriate remedy ; and it might be 
successful if practiced early, before the health becomes 
much impaired, or the ulceration extensive. 



CHAPTER XIII. 

CANCER OF THE UTERUS AND OVARIA NATURE CAUSES- 
SYMPTOMS AND TREATMENT. 

Cancer is the most fearful and destructive disease to 
which the female genitive apparatus is obnoxious ; it is 
the most fatal in its progress, and the least controllable by 
remedies. Although it is frequently met with, it is, com- 
paratively, not a common malady. It may be defined to 
be a disease arising from various causes, which are often 
obscure : frequently from hereditary predisposition, in tha 
the middle or advanced periods of life ; commencing with 
a local hardness, consisting of a morbid deposit in gland- 
ular parts, which subsequently ulcerates, most commonly 
in its centre, destroying surrounding parts, and ultimately 
contaminating the constitution — being attended with ema- 
ciation, and generally considerable, and not unfrequently 
intense pain. 

It most often attacks the uterus in the glands of the 
neck, at about, the period of the cessation of the menses, 
and single women, or those who have borne no children, 
seem to be most obnoxious to it ; young persons being 
mostly exempt from its ravages. The following table, 
from Madam Boivin and M. Duges, throws much light 
upon the time of occurrence of this disease. 

Out of 409 cases of cancer of the uterus, there were : 

Under 20 years of age, 12 

From 20 to 30 " 83 

" 30 " 40 " 102 

Following the course of the disease, from its commence- 
ment by a hard morbid deposition, that after some time, 
longer or shorter, ulcerates by softening in the centre, 
there are two distinct stages, which we shall consider 
separately : 1. That of hardness, known as scirrhus, or 



ron 


i 40 to 50, 


201 


a 


50 " 60, 


7 


u 


60 " 70, 


4 



CANCER OF THE UTERUS CAUSES. 245 

cancer. Some authors have included diseases, which we 
have more properly described under other heads (corrod- 
ing ulcer and cauliflower excressence) as varieties of cancer, 
which has given rise to much discrepancy and confusion. 
Other authors have made a distinction, into cancerous 
ulcer and ulcerated cancer; in the former the ulceration 
being the primary affection, and the morbid deposition 
secondary ; we should remark, that though this species 
has occurred, it is extremely rare. 

1. Scirrhous stage : At the commencement, it is distin- 
guished by hardness, coldness, insensibility, paleness, and 
a. deficiency of red blood-vessels — all indicating a low 
degree of vitality. When fully developed, it consists of 
a hard, firm, incompressible and unequal mass, the limits 
of which are not distinctly definable ; its color is generally 
of a light grey, and when cut into thin slices, semi-trans- 
parent. Upon close examination, it is found to consist of 
two distinct substances : the one which composes the chief 
part of the diseased mass, is hard, fibrous and organised ; 
the other is soft, and apparently inorganic. 

At the commencement of scirrhous disease of the ute- 
rus, the organ, for sometime preserves its natural aspect 
and color, being changed merely in volume and density ; 
as the disease advances, the tissue of the organ becomes 
more obscure, until it entirely lose-s its normal character. 

2. Cancerous stage : Soon, portions of the scirrhous 
mass begin to soften, and pass into a state of unhealthy 
ulceration. The soft or inorganic substance, above no- 
ticed, forms a thin ichorous matter ; the establishment of 
this condition appears to arrest the deposition, as the uterus 
increases but little in bulk after this period. 

Cancerous tumors always have a tendency to extend to, 
and contaminate the glands in their vicinity. Conse- 
quently we find, that after a while the glands in the pel- 
vis, and even those in' the groin, often participate in 
the disease. The vagina, bladder, and rectum, and even 
the ovaria and tubes, may also become affected. 

Causes. — The predisposing causes, are heredetary pre- 
disposition, age, constitution, mode and habits of life. It 
will be seen by referring to the statistical table before 
given, that cancer of the uterus is mexo frequent in pro- 
12 



246 CANCER OF THE UTERUS SYMPTOMS. 

portion as that organ is in a greater state of activity, and 
particularly just before and after the " change of life." 
Badly regulated women ; those who are nervous and sub- 
ject to vivid emotions ; those of an erotic temperament, 
who give themselves up to masturbation or venery ; those 
who pass their lives tumultuously in fashionable society ; 
those in whom an habitual leucorrhea, and neuralgic or 
rheumatic pains have suddenly ceased ; finally, women 
who have borne many children, or have had numerous 
abortions, are more subject than others to cancer of the 
womb. We should also mention as belonging to this 
class, sterility, celibacy, violent grief, strong paroxysms of 
anger and joy, etc. Although no temperament is exempt, it 
would seem that women of high color and sanguinous con- 
stitution, are its most frequent subjects. 

The exciting causes, are all those w r hich give rise to 
inflammation of the uterus, mechanical violence, as blows, 
long-continued and inordinate local pressure; criminal 
attempts to prevent conception and to procure abortion ; 
the presence of a foreign body in the vagina ; contusions, 
from disproportion of the organs in married people ; mas- 
turbation and venery before puberty and after the critical 
age; and finally, all causes capable of producing inflam- 
matory and congestive engorgements of these organs. 

Symptoms. — 1. Scirrhus : The symptoms, at first, are 
so very slight, as not to excite uneasiness, till the disease 
has made considerable progress. Then, the menses may 
be deranged, either by augmentation, diminution, tran- 
sient suppression, or frequent and irregular return ; there 
may be a leucorrheal discharge, with a redder tint after 
coitus ; sensations of pressure, weight and dragging in the 
loins, and about the anus ; and painful sensations during 
the expulsion of the urine and fseces. Some women ex- 
perience a sort of voluptuous pruritus in the genital parts ; 
marital connexion, generally, though not always, causes 
more or less acute pain ; to these symptoms are added 
acute pains in the breasts and different parts of the body, 
melancholy, hysterical attacks, disgust for food, and strange 
longings. 

When such symptoms as these occur, it is of the great- 
est importance to make an examination, to ascertain the 



CANCER OF THE UTERUS SYMPTOMS. 2-17 

nature of the evil ; delay might expose the patient to 
irremediable danger, as this is the only period in which 
the disease is, in the least, amenable to treatment. The 
mouth of the uteres is found more open than usual, tume- 
fied, hard, warm, and painful, and sometimes softened, 
and uneven at different points ; the posterior lip is found 
larger and more projecting than the anterior ; and the 
finger, when withdrawn, is commonly found covered with 
bloody mucus. It may often be difficult to distinguish the 
first stage of cancer from chronic inflammation, but in 
either case not a moment should be lost in the application 
of remedies. 

It is certainly very remarkable, that so grave a disease 
should admit, during its progress, of the possibility of con- 
ception: this, however is the fact, for several such cases 
are on record. 

2. Cancerous stage : How long the first stage may 
continue is uncertain : in some patients, it may last for 
years, and in others, for a much shorter period. There 
are three symptoms at this stage which deserve particular 
attention, viz : the pain, the hemorrhage, and the dis- 
charges. 

1. The pain: The pain in cancer of the uterus is quite 
distinctive ; it is described as lancinating, as though 
knives were being plunged into the body. It, however, 
varies, being sometimes burning, and occasionally, there 
is very little of any kind. Its location is through the 
pubes and loins, and down to the anus and thighs ; some- 
times it is situated in distant organs. 

2. The hemorrhage : This occurs very soon after the 
ulceration commences ; in many cases it precedes the 
pain and is the first symptom that excites the alarm of 
the patient. It is frequently mistaken for monorrhagia ; 
but its real character must be ascertained by a vaginal 
examination. 

The amount of blood lost varies a good deal in differ- 
ent persons ; it is some times very large. The progress 
of the ulceration appears to be arrested, and the pain 
relieved for a short time after each flooding : though the 
weakness of the patient is much increased. 

3. The discharge : The moment ulceration commences 



248 CANCER OF THE UTERUS SYMPTOMS. 

the odor of the discharge becomes fated and almost insup 
portable ; its color varies from a dirty white to a dark 
brown, green, or black, occasionally tinged with blood, 
Besides being a great annoyance to the patient it now 
almost forbids that degree of attention from friends which 
is so consoling to the sick. It is also extremely acrid, 
giving rise to extensive excoriations around the mouth of 
the vagina, and extending to the anus. 

After some time,- the bladder and rectum become still 
more affected, producing much suffering from dysuria and 
tenesmus ; and when the ulceration reaches those organs 
causing their contents to be discharged into the cavity of 
the pelvis, and even reaches to the external organs, the 
measure of the sufferings of the patient is full. • 

When a woman reaches this frightful period of the dis- 
ease, she presents the most heart-rending picture of human 
misery ; in fact, the functions of assimilation are exhaust- 
ed ; appetite is gone, digestion is deranged in a thousand 
ways ; emaciation, more or less rapid, sometimes passes into 
mai*asmus ; the osseous system participating in the disease, 
becomes fragile, and breaks of itself, as it were. The 
skin, which is dry, swollen, wrinkled, and adherent to the 
bones, assumes the dull, white color of wax, or the yellow 
straw color which characterizes cancerous affections ; the 
attitude has a peculiar character in this diseased condition ; 
the sad and drooping expression bears the impress of suf- 
fering and depression ; the eyes sunken in their orbits, 
the livid and singularly contracted lips, the fuliginous 
teeth, the drawn hippocratic face, furrowed with deep 
wrinkles, give to the patient the aspect of a corpse : finally, 
colliquative diarrhoea, symptomatic of intestinal ulceration, 
vomiting, general dropsy, hectic fever, insomnia, intoler- 
able sufferings, profuse hemorrhages, despair and death 
come to complete this sad and afflicting scene. (Colombat.) 

Although the order of symptoms we have described, 
are observed in most cases of cancer of the womb, yet, of 
course, there is more or less variation ; in rare cases, as 
we have remarked, there will be little or no pain, and in 
others, but little hemorrhage. The prognosis is extremely 
unfavorable. Care must be taken to distinguish this dis- 
ease — 1. from simple induration and ulceration; 2. from 



CANCER OF THE UTERUS TREATMENT. 249 

Jibrous tumors, moles, and hydatids; 3. from corroding 
ulcer. 

Treatment. — Whether this formidable disease is curable, 
even in its earliest stages, is, to say the least, questionable. 
Notwithstanding, many able men have employed certain 
remedies against what they supposed to be cancer, and, 
according to their testimony, with beneficial results: those 
who have flattered themselves that they have succeeded 
in curing it, have probably been deceived by their success 
with ulcers resembling the one in question. The reme- 
dies which have been used at different periods with appa- 
rent success, are cicuta, bitter tonics, with alkalies, bella- 
donna with rhubarb, hydrochlorate of baryta, cyanuret of 
lead, oxyde or muriate of gold, iodine, etc. 

All our means should have for their object, to arrest and 
crush the disease at its origin ; to remove all exciting 
causes, and prevent its return by the most attentive care. 
There seems to be good reason to suppose that the primary 
source of cancer of the uterus, is chronic inflammation of 
that organ ; therefore, to avoid and cure this disease, 
upon which cancerous engorgement often, to say the least, 
depends, is to save the woman from the most frightful of 
diseases. Even when we can do no more, so' long as the 
complaint can be kept in the first stage, the life of the 
patient is in no immediate danger, and her comfort but 
slightly interfered with. 

1. Scirrhus: The treatment of the first stage of cancer 
is nearly the same as that directed for chronic inflammation, 
and simple ulceration of the uterus. (See those chapters.) 
The indications are, revulsive bleedings, exutories, and a 
soothing regimen ; a milk diet should be directed, white 
meats, repose, baths, emollient, narcotic and astringent in- 
jections, enemata, poultices of the same nature, and the 
other remedial agents, and hygienic directions, already 
mentioned. 

The diet should be restricted and simple ; the patient 
should be gradually deprived of about one half of her ordi- 
nary food. Milk and vegetables should principally com- 
prise the articles used ; white meats and fish may be cau. 
tiously used, if milk does not agree ; bread, rice, Indian, 
or rye mush, or that made from the unbolted wheat, are 

L 



250 CANCER OF THE UTERUS TREATMENT. 

particularly applicable, as they obviate costiveness. Everv 
thing stimulating must be prohibited, whether food or 
drinks. The fruits of the season may be allowed, with 
tapioca, oat meal, sago, Indian meal, gruel, etc. Let it 
be remembered that a low diet is an important means in 
the treatment of cancer. 

Bleeding should be employed, with care, where pletho- 
ra exists; bleeding from the arm", if the pulse indicate 
it, otherwise, cupping the loins, and the application of 
leeches to the vulva and thighs. Tepid, general bathing 
is very useful ; and mild purging, with neutral salts, rhu- 
barb, etc., must not be neglected. 

Tlie injections must be sometimes emollient, as starch, mu- 
cilage, etc., at others narcotic, or slightly astringent, accord- 
ing to circumstances. Irrigations, or prolonged injections, 
either simple or medicated, are still more powerful means. 
Absolute repose must be directed-, and during the day on a 
matress thrown upon the floor. 

Narcotics, internally, as morphine, opium, hyosciamus, 
and cicuta, and by injections of decoction of poppy heads, 
hyosciamus, etc., to relieve pain, will be found useful. 
Also, iodine should be perseveringly given : lime water, 
extract of cicuta, and the ergot have been recommended. 
The foetor of the discharge may be destroyed, or much 
lessened, by injections of a solution of chloride of soda 
and creosote. For the purpose of moderating the profuse 
watery discharge and hemorrhage, we must resort to cool- 
ing astringents, internally, and by injection ; but it should 
be remarked that their suppression invariably hastens the 
progress of the ulceration. Lastly, we should mention 
among the means of relieving the sufferings, and prolong- 
ing life in these disastrous cases, the use of the catheter 
for the purpose of relieving the bladder; and, also, in con- 
stipation, the use of mild laxatives, as decoctions of tama- 
rinds and prunes, as well as enemata of honey and olive 
oil, etc., and by appropriate suppositories. Constant atten-. 
tion to cleanliness is to be observed throughout the disease. 

2. Cancerous stage: The treatment now becomes more 
complicated, but less effective in relieving the patient. The 
rapidity of the progress of the disease is greatly increased 
and all we can expect to do by the power of medicine is, 



CANCER OF THE OVARIA. 251 

to give temporary relief by a sedulous application of all 
those means just mentioned for the first stage. The ques- 
tion of calling in the aid of surgery must now be decided, 
as no remedy is supposed to be too desperate, which offers 
the slightest chance of relief; according to the extent of the 
destruction, either excision of the neck, or extirpation of 
the whole uterus has been proposed ; but of these formid- 
able operations, it does not come within our purpose to 
speak, in this volume. 

— — 

Cancer of the ovaria is, without doubt, the most seri- 
ous disease to which those organs are exposed. It is 
quite as frequent as cancer of the breast, which we are 
soon to notice, and nearly as much so as cancer of the 
uterus. Its time of occurrence varies a little from the 
last named disease, appearing more frequently during the 
middle period of female life. 

There are very few circumstances in which this malady 
differs from the one last described ; it presents about the 
same characters and symptoms, which only vary in the 
first stage on account of the difference in location. Its 
progress, particularly in the first stage, is slower, and it 
attains a much larger size ; it frequently occupies years 
in forming, and is in its last stage often associated with 
uterine cancer. It probably originates from, and follows, 
as in the uterus, chronic inflammation. Indeed, when we 
reflect upon the activity of the ovaria, and the derange- 
ments to which their function is subject, (which we have 
enumerated,) at every epoch of menstrual life, it is not 
wonderful that they are liable, at a later period, to more 
serious disease. Its treatment, when fully established, 
is only palliative, the same as previously mentioned for 
cancer of the uterus, by which life may be much prolong- 
ed. It is unnecessary here to repeat those cautions of at- 
tention on the part of the female to earlier derangements, 
that we have so often pointed out in the course of this 
work, by which, without doubt, these more serious mala- 
dies might be often avoided. 



CHAPTER XIV. 

CANCER OF THE BREAST CAUSES SYMPTOMS AND TREAT- 
MENT. 

- It is a sad reflection that woman, who is destined by- 
nature to give us existence, while in the performance of 
those high duties, should become the victim of the most 
fearful diseases. Cancer of the breast, from its being 
more easily observable, and accessible, has excited more 
attention, and is more within the reach of the healing art, 
than the occurrences of it already described. 

Nothwithstanding the mammary glands are originally 
the same in both sexes, this disease but rarely attacks the 
male, while it is a common affection of the female, occur- 
ring most frequently in those in whom the peculiar func- 
tion of the breasts has been brought into action by child- 
bearing. Its most frequent occurrence being connected 
with the great afflux of blood to the breasts for the secre- 
tion of milk, it may be reasonably supposed the result of 
a chronic inflammation there generated from various causes, 
which we shall more particularly describe when we speak 
of inflammation of the breasts, in Book II., of this volume. 
Cancer of the breast has been met with at the age of twenty 
and of thirty, but much more frequently at a more ad- 
vanced period. There are several varieties of this dis- 
ease, which it is unnecessary for us to dwell upon. 

Causes, — First, among the exciting causes of this for- 
midable disease, may be mentioned, the pressure of tight 
corsets, adjusted with a view of pushing the breasts up- 
wards, or, on the other hand, to flatten them and lessen 
their apparent size ; the inconsiderate use of discutient 
applications to the breasts, when inflamed or affected with 
simple and chronic engorgements ; the sudden impression 
of cold air, especially soon after a confinement, and the 
astringent applications designed to check the secretion of 
milk ; in short, any thing which has the effect of irritating 



CANCER OF THE BREAST TREATMENT. 253 

this organ, and giving rise to milk or congestive engorge- 
ments, produces a condition which may degenerate into 
cancer. Other internal causes may be mentioned, as irregu- 
larities and suppression of the menses ; the cessation of a 
chronic leucorrhea, an old issue, or piles, and certain cu- 
taneous eruptions ; the metastasis of gout, rheumatism, 
erysipelas, etc. — all of which may give rise to cancer, 
particularly when a certain predisposition to it already 
exists, known as the cancerous diathesis. 

Symptoms. — As these do not vary, excepting in a few 
slight particulars, from the general course of those enu- 
merated under cancer of the uterus, we shall only mention 
the following unmistakable characteristics : the tumor, 
which is seated upon some part of the breast, is hard, un- 
equal, indolent, insensible to pressure, movable with the 
fingers, and the skin is of a natural color ; if this tumor 
have existed for some time, and particularly if it have 
resisted the treatment for scrofula and chronic inflamma- 
tion, and become the seat of sudden, lancinating pains, its 
character need not be doubted. 

By degrees, the tumor increases, and at length it soft- 
ens in some place or places ; the glands of the axilla be- 
come swollen, hard, painful, and filled sometimes with 
cancerous matter ; the tumor breaks, perhaps through the 
skin, and presents the shocking spectacle of "open can- 
cer ;" the general health gives way, and the skin presents a 
straw colored tint. During this process, unless the patient 
die prematurely, or the original disease be removed by a 
surgical operation, cancerous tumors form in one or in 
several of the internal organs, and give notice of their 
presence by appropriate symptoms. (Watson.) Our space 
will not allow of our pursuing the subject further, in paint- 
ing the horrors of its progress and termination ; neither is 
it necessary, and we shall close the subject by pointing 
out the most appropriate remedies for its relief. 

Treatment. — The treatment of cancer of the breast is 
divided into the preventive, the curative, and the palliative. 

1, The preventive: This consists in combating and re- 
moving by the most suitable means, certain diseases and 
derangements of the functions which, it is supposed, may 
Prove to be the sources of cancer ; such as milky engorge- 



554 CANCER OF THE BREAST TREATMENT. 

ments, and the different acute and chronic inflammations 
of the breasts, scrofulous swellings, so called, etc. Time- 
ly attention to these various affections is of the utmost 
importance. The preventive treatment, therefore, is 
nothing more than the curative treatment of the pre-exist- 
ing disease. It is by this method that many distinguished 
physicians, having dissipated the various chronic engorge- 
ments of the breasts, have believed that they have cured 
cancer, when, in fact, they have only prevented it. 

The treatment of such engorgements and tumors of the 
mammae, consists, first, in removing the causes, when they 
are discoverable, and then resorting to the employment of 
different means, which will be more particularly pointed 
out in Book II., under inflammation of the breasts. We 
remark here, that if the disease be in the acute stage, and 
the woman plethoric, a general bleeding will be useful; 
then the application of leeches about the tumor, which 
should afterwards be covered with an emollient poultice. 
An observance of the following directions will very mnch 
contribute to a cure : a mild diet, the same as mentioned 
under cancer of the uterus ; demulcent and diaphoretic 
drinks } bathing and frictions of the skin ; moderate ex- 
ercise, avoiding violent movements of the upper extremi- 
ties, so as not to interfere with the diseased gland ; resi- 
dence in a dry and well aired situation ; gayety, with 
quiet and agreeable amusements ; and, finally, a perfect 
performance of all the functions of the economy. 

As soon as the tumor ceases to be painful, by the em- 
ployment of these various means, and not before, discutients, 
and resolvents, may be made use of, with the precaution, 
however, at first, of associating them with emollients, lest 
they produce inflammatory action. Poultices of flax-seed, 
etc., with elder flower water, infusions of camomile, de- 
coction of roses, or soap and water, may be used ; then, 
stimulating liniments, and plasters, as the camphorated, 
ammoniated, and mercurial ; and, lastly, great good may 
be expected from the use of the tincture of iodine, exter- 
nally, as well as internally. At the same time, the bowels 
must be kept free by mild aperients, and some of the bit 
ter tonics and alteratives should be exhibited. Small blis< 



CANCER OF THE BREAST TREATMENT. 255 

ters, and the occasional application of leeches to the part 
affected, have, also, been recommended. 

2. The Curative: Whatever designing individuals may. 
say to the contrary, confirmed cancer is incurable by the 
resources of medicine alone ; it is so regarded by almost all 
the eminent physicians of modern times ; there is no 
other remedy than the knife. We cannot better present 
and fortify our sentiments upon this subject, than by mak- 
ing the following extracts from Dr. S. Cooper, of London : 
" When the breast is affected with scirrhus, or ulcerated 
cancer, the imprudence of tampering with the disease 
cannot be too severely censured. Were the disorder un- 
attended with a continual tendency to increase, some time 
night be. properly dedicated to the trial of internal reme- 
dies and external applications, which have acquired any 
character for doing good in these unpromising cases. But, 
unfortunately, by endeavoring to cure the disease by medi- 
cine, we only afford time for it to increase in magnitude, 
and at length attain a condition in which, even the knife 
cannot be employed to take away the whole of the diseased 
parts. When the case is marked by the characteristic 
features of scirrhus, noticed in the article cancer, the 
sooner the tumor is cut out the better. 

" There are, also, some malignant kinds of sarcoma, 
(fleshy tumors,) to which the female breast is subject, 
which cannot be removed at too early a period after their 
nature is suspected or known. Indeed, though there is 
not equal urgency for the operation in many other tumors, 
yet, as the most of them are continually growing larger, 
and little success attends the attempt to disperse them, the 
practitioner should never devote much time to the trial of 
unavailing medicines and applications, and let the swelling 
attain a size which would require a formidable operation 
for its excision. It is, also, to be remembered, that many 
simple, fleshy, indolent tumors, are accompanied with a 

ijertain degree of hazard of changing into very malignant 
brms of disease." 

Experience proves that, most often, when cancer is 
removed in its early stages, it is successful in preserving 
the patient from a lingering and awful death. Even if the 
disease return after a few years, as it occasionallv will, 



£56 CANCER OF THE BREAST TREATMENT. 

the condition of the patient is far better, and the suffering 
inconceivably less, by submitting to the operation ; and 
now, that it can be done while the patient is wholly un- 
conscious — under the influence of sulphuric ether — she 
ought not to hesitate. For the purpose of guarding our 
readers against a certain class of empirics who infest the 
country, professing to cure cancer, we quote the following 
sensible and very true remarks of Dr. Dixion's, upon the 
subject of "cancer plasters": "It is a deplorable reflec- 
tion, that human cupidity can be found of so base a char- 
acter, as not to scruple to speculate upon the infirmities 
and lives of the unfortunate : but so it is. We are con- 
stantly reminded of the weakness of our moral nature, by 
the facility with which the unfortunate are induced to use 
remedies boldly announced as capable of curing cancer, 
aided by the attestations of others, who corroborate their 
assertion, from ignorance of the disease. 

" If the mind, under suffering, only retained its calm- 
ness, there could not be so much error on this subject. 
None of these empirics pretend that their remedies do not 
produce pain ; they are all employed to ' eat out the can- 
cer.' Several weeks' application is often necessary, ac- 
cording to their own account ; and then, should the sore 
heal up, it is certainly evidence that it could not have been 
cancer ; for> in the name of reason, how could the plaster 
evince such discerning powers, as to select the diseased 
parts and leave the sound flesh? The surgeon uses the 
greatest care to include, in his rapid incisions, every parti- 
cle of the ' hardness,' well knowing if he does not, the 
disease must return. Arsenic, mercury and lead, in some 
of their forms are the basis of these plasters ; and the in- 
expressible agony — as we have been told by those who 
have undergone their application, and, after all, been 
obliged, when too late, to submit to the operation — is far 
greater, each moment of their action, than the knife ; and 
this continues for days, and often weeks together. It i» 
but a short time since the coroner was called to inspect 
the body of the unfortunate mother of a family in this 
city, who had been poisoned by the absorption of arsenic 
from a plaster applied by one of these wretched traffickers 
in human life. We were called to see another, who had 



CANCER OF THE BREAST TEEATMENT. 257 

lost an eyelid by the corrosive action of a similar prepa- 
ration ; and this, too, as she assured us, for a trifling en- 
largement of a little blood-vessel — ' a mere speck, the size 
of a pm's head,' as she expressed it — that had remained 
from infancy to her twenty-fifth year ! What more con- 
clusive evidence that it was not a cancer, could there be? 
Cancer never attacks an infant, as every one knows." 
These cases, and similar ones,, are numerous all over the 
Union : sufficiently so, it would seem, to demand the at- 
tention of Government, to prohibit such fatal practices. 

Palliative treatment : When cancer of the breast, from 
extensive destruction of the parts, is no longer in a condi- 
tion for an operation, or, when the patient refuses to sub- 
mit to the operation, certain remedies are useful in pro- 
longing life, and in more gently conducting her to the 
grave. With this view, a milk and vegetable diet, with 
the white meats only, should be allowed. The pain and 
nervous symptoms must be opposed by opiates and anti- 
spasmodics, in the form of potions, pills, enemata, etc.; 
also, anodyne, fomentations, and cerates to the part ; and, 
finally, the use of baths, and the occasional application of 
leeches, are not to be neglected ; and happy for them, if 
they can add to the oblivion of their ills, the sweet illusions 
of hope .' 

There are a variety of other fumors of the breast, that 
require about the same treatment as cancer ; the principal 
of these are, the encysted, and fibrous tumors ; which, from 
their liability to degenerate into malignancy, should, with- 
out hesitation, be extirpated. Finally, scrofulous tumors 
of this part, which are sometimes followed by ulcers of 
cancerous appearance, but readily distinguished by the 
absence of shooting pains, etc., rarely resist the anti-scrofu- 
lous treatment, which is by the internal and external 
exhibition of the preparations of iodine. 



CHAPTER XV. 

DISEASES OF THE OVARIA AND FALLOPIAN TUBES ENCYSTE1 

DROPSY CAUSES SYMPTOMS AND TREATMENT. 

Diseases of the ovaria and Fallopian tubes are, in 
general, so obscure, that we need not, in this work, enter 
intimately into their description. In treating of the disor- 
ders of the uterus, we referred to similar affections of these 
organs, for the purpose of showing their connection; such 
as acute and chronic inflammation, fibrous tumors , displace- 
ments, and cancer ; all of which, are more or less com- 
mon to all these organs, and occur under similar circum- 
stances. We now refer to them for the purpose of their 
inclusion in one view, and of showing their relation to 
an important disorder, which is the subject of this chapter. 

Chronic inflammation of the ovaria, from causes which 
will soon be pointed out, is now charged with the agency 
of producing these abnormal degenerations, as well as 
those which we are now to mention* The organs that are 
now under consideration, have been found, in making dis- 
sections, to contain hair, portions of bone and teeth, which 
are sometimes supposed to be relics of abortive concep- 
tions, and at others, of monstruous or unnatural formations, 
inasmuch as they have been found in other parts of the 
body, and even in males, and virgins before puberty. 
Such preternatural products have often been met with, 
but as they rarely grow to a large size, their existence is 
seldom suspected during life. Chronic inflammation, too, 
besides ending in abscess, induration, and the diseases 
above mentioned, very often gives rise to encysted tumors, 
known as dropsy of the ovaria. 

Encysted dropsy of the ovaria is one of the diseases 
to which the female is most liable : although it has been 
known to attack young females who have not menstruated, 
it is far more frequent during the period in which the 



ENCYSTED DROPSY OF THE OVARIA CAUSES. 259 

ovaria are in the full performance of their functions. The 
disease consists merely in a morbid accumulation of fluid 
in one or more of the Graafian visicles, or in the Fallopian 
tubes. Notwithstanding, it is probable that the formation 
of these cysts is-always the same, it has been divided into 
several varieties, which it is not necessary to notice, they 
having reference principally to the number of cysts, or 
sacks, that contain the morbid fluid, of which the disease 
consists. 

The texture of an ovarian cyst is fibrous : sometimes 
very thin, and at others, on the contrary, very thick. The 
fluid is generally serous ; it may be limpid, ropy, albumi- 
nous, gelatinous, sanguinous, purulent, of a chocolate color, 
or like coffee grounds, etc.: it sometimes undergoes putre- 
factive decomposition. The quantity of this fluid varies 
very much in different cases ; at first, the accumulation 
is scarcely perceptible, but it may become enormous : from 
fifty to one hundred pounds, and even more, has been men- 
tioned as having been found. At first, but one of the ova- 
ries is generally affected, but when it is of long standing, 
both almost always become implicated. It should be re- 
marked, that this disease is often combined with a cancer- 
ous state of the cyst. 

Causes. — The disease rarely occurs before puberty, or 
after the "change of life," and most commonly at that period 
of life during which the genital organs are most active ; 
which is from the twentieth to the forty-fifth year ; and 
particularly in women who have borne children. So, that 
age may be said to be a predisposing cause. The exciting 
causes are the same as those enumerated as giving rise to 
inflammation of the uterus : the principal of which are, 
external violence, such as blows and falls ; irritation and 
excitement of the reproductive system by masturbation, 
and excessive coitus; deranged menstruation; passions 
and emotions of the mind, etc. 

Symptoms. — The symptoms of this disease, at first, are 
very obscure. When it becomes advanced, they so much 
resemble the signs of pregnancy, that the female often 
supposes herself in that situation : there is a gradual en- 
largement of the abdomen, as well as of the breasts ; the 
menses are suppressed; there is vomiting, capricious ap- 



260 ENCYSTED DROPSY OF THE OVARIA SYMPTOMS. 

petite, etc. The progress of the tumor is generally very 
slow — often requiring several years to make it perceptible 
externally. Before it becomes sensible to the touch, the 
woman, most often, has a dull pain and a sensation of 
weight in the groin and hip ; soon after which, the tumor 
may be felt near one of the groins, generally character- 
ised by fluctuation. When the encysted tumor attains a 
considerable magnitude, the adjoining viscera being more 
or less displaced, and inflamed by the pressure, attract 
adhesions with each other, as well as with the tumor 
itself; this gives rise still more to dragging sensations 
upon any change of position by the patient. The uterus, 
also, is variously displaced ; it is sometimes pressed over 
to the side of the pelvis — at others, deeply depressed by 
the weight of the tumor. 

When the cyst becomes large enough to push the bow- 
els and stomach upwards against the diaphragm, the pow- 
ers of digestion, as well as the respiration, are embarrass- 
ed. Obstinate constipation, and sometimes dysuria, now 
supervene ; the fluctuation becomes more evident, and the 
fluid, which appears to occupy the whole abdomen, often 
leads to a belief that the case is one of ascites or general 
dropsy of this region. Sometimes, when the tumor has 
arrived at this stage of its development, it remains station- 
ary for several years ; but, generally, when the encysted 
tumor becomes very large, the patient is incapable of 
much motion, from the great disorder of the functions, 
caused by its pressure ; and lastly, there is imminent dan- 
ger of sufFocationj painful and obstinate constipation, sup- 
pression of urine, and a hectical form of fever is liable to 
supervene, which is the forerunner of approaching disso- 
lution. 

Before the tumor descends from the cavity of the pel- 
vis, it may be discovered, by an examination per vaginam 
and per rectum, between those two organs. After its as- 
cent into the abdomen, an examination will reveal the 
elevation of the uterus. In order to distinguish it from 
other affections of this region, a close attention is neces- 
sary to all the circumstances attending the progress of the 
abdominal tumor. 

Treatment. — At an early period of the disease, whilst 



ENCYSTED DROPSY OF THE OVARIA — TREATMENT. 261 

the tumor is in the cavity of the pelvis, there is some 
hope in a palliative course of treatment, though the suc- 
oess heretofore, has been very limited. A great number 
of remedies have been employed, which are at present 
abandoned. At first, alterative diaphoretics may be used, 
such as sarsaparilla, guaiacum, and the preparations of 
iodine, internally as well as externally, in the form of 
ointment; also, sea bathing or salt water baths; and 
antimonial friction, or small blisters and bleedings upon 
the abdomon. Diuretics may be useful, as squills, nitre, 
etc. And lastly, purgatives deserve a trial, in connection 
with the other remedies, such as rhubarb, aloes, croton 
oil, etc., in small doses. These, with a low diet, and 
compression of the abdomen, are about all the means that 
can be resorted to with a prospect of producing absorption 
of the effused fluid. Sometimes relief may be obtained 
by pushing or assisting the tumor out of the pelvis, into 
the abdomen. When the cause of the disease can be de- 
tected, it must, of course, be instantly removed ; an ap- 
propriate system of hygiene, also, should not be neglected. 

When the tumor has ascended into the abdomen, it is 
generally ackisable to postpone surgical interference as 
long as possible ; but when it becomes so large as to much 
interfere with the vital functions, the fluid should be 
evacuated by the operation of tapping, which, though 
somewhat dangerous, is not very often fatal. This opera- 
tion is resorted to as often as becomes necessary from a 
re-accumulation of the fluid. A remarkable case of this 
kind, is on record in the Philosophical Transactions of 
England for the year 1784, wherein the complaint began 
after a miscarriage, at the age of twenty-seven. From 
the year 1757 to 1783, when she died, she had been tap- 
ped eighty times, and had in all, evacuated 6631 pints 
of fluid, or upwards of thirteen hogsheads. The largest 
quantity taken away at any one time was 108 pints. 

Finally, we should remark, that from time to time, 
■tirg< ons of talent have attempted the removal of diseased 
ovinia by the knife, which has been done with success. 
Still, when we compare the chances of its being success- 
ful with the great number of deaths that have resulted 
prom it, and consider the formidable nature of the opera- 
12* 



262 CONCLUSION OF BOOK PIRST. 

tion we cannot forbear being unfavorably impressed in 
regard to its practicability. It is our opinion, that in the 
majority of cases, the chances of life for the female, are 
in favor of a palliative course of treatment ; this will 
often enable her to arrive at the allotted age of life, under 
comfortable circumstances. 



We here conclude our remarks upon this part of our 
subject, viz. : the physiology of woman and her dis- 
eases, INCLUDING ALL THOSE OF HER CRITICAL PERIODS ; by 

which, is understood, of course, the physiology and dis- 
eases peculiar to females ; those relative to pregnancy 

AND CHILDBIRTH, WITH THE MANAGEMENT OF PREGNANT AND 

parturient females, which figure in our Title Page and 
Table of Contents, are sufficiently numerous and impor- 
tant, to constitute a separate consideration, and will form 
the subject of Book II., of this volume which immediately 
follows. 

Though it is evident from the sad and lengthened pic- 
ture we have just traced in enumerating the various mali- 
dies to which woman is subject, that there is truth, though 
exaggerated in the declaration of Democrittis in his let- 
ter to Hippocrates, in which he says " Uterus sexcentarum 
cerumnarum in mulieribus causa" — and that though many 
of them are extremely serious — it is also evident, that we 
may generally hope for their prevention and cure, by 
applying in due time, the various hygienic and remedial 
agents at the same time enumerated. 

It was never intended by a beneficient Deity that wo- 
man, one of the most beautiful objects of creative power, 
should become the subject of numerous and painful diseases. 
We have no hesitation in saying, in conclusion — being 
greatly impressed of its truthfulness — what is of the 
greatest importance for females to understand that, in 
general, women may avoid most, if not all, of the disorders 
to which they are incident in their present condition by con- 
forming to the intentions of Nature in their creation, or in 
other words, by living physically and mentally according to 
the normal organic and moral laws. 



BOOK II. 



THE PHYSIOLOGY 

OF 

PREGNANCY AND CHILDBIRTH 

WITH THE 

DISEASES INCIDENTAL THERETO. 



363 



THE FGETAL CIRCULATION.* 




* The child is represented with the trunk and abdomen laid open, and 
the placenta or after-birth, with the umbilical cord consisting of 
two arteries and one vein j the mode of connection is seen between die 
placenta and child, for the nourishment of the latter. 

1. 1. The placenta. 2. The umbilical cord or vessels — their union 
with the placenta is seeu. 3. 3. The umbilical arteries. 4 4. The 



THE 

PHYSIOLOGY AND DISEASES 

OF 

PREGNANCY AND CHILDBIRTH. 



PART I. 

INTRODUCTORY REMARKS. 

Notwithstanding the term disease has been applied to 
designate the various sympathies which are called forth 
by pregnancy, it is retained only for the purpose of giv 
ing a more intelligible explanation of the temporary com 
plaints that arise in by far the greatest majority of women 
while in that condition. The state of pregnancy, may be 
regarded as an altered, but cannot with propriety be 
termed a morbid state ; on the contrary, it is well known, 
that in order to have this process carried on agreeably to 
the arrangement of nature, it is essential that -the fetus 
and uterus, both retain, almost perfectly, their healthful 
integrity. For if either the one or the other become dis- 
eased to any extent, the intentions of nature of forming a 

umbilical vein. 5. The ascending vena cava which discharges into the 
right auricle of the heart, carrying the placental blood into the circula- 
tion of the child. 6. The left lobe of the liver. 7. The heart. 8. The 
aorta. 9 The descending aorta artery. 10.10 The iliac arteries — the 
commencement of the umbilical veins is seen, which return the blood to 
the placenta. 

The blood is brought from the placenta, (which during gestation is ad- 
herent to the uterus of the mother) by the umbilical vein ; much of it 
is spent in its passage through the liver — the remainder is carried into 
the left hepatic vein, and from thence by the ascending vena cava into the 
right auricle of the heart. During foetal life, there being a passage fioin 
the right to the left side of the heart by the foramen ovale, much of the 
blood passes through that opening, the communication by the lungs not 
being established till respiration takes place. From the left side of the 
heart the blood is discharged into the aorta; finally, it passes down- 
wards to the iliac arteries, and is conveyed from thence back to the pla- 
centa by the umbilical arteries. 



266 INTRODUCTORY REMARKS. 

new and living being, will certainly be frustrated. Still, 
while they are preserved in the most healthy state, they 
possess the power of exciting deranged, and, under certain 
circumstances, diseased action, in other parts ; and Dr. 
Denman remarks, what most practitioners of midwifery 
have observed, that those women are less subject to abor- 
tion, and ultimately fare better, who have such symptoms 
as generally attend pregnancy, than those who are ex- 
empt from them. 

Pregnancy, then, should be regarded as a physiologi- 
cal condition, which sometimes borders so closely on the 
pathological, that it is difficult to distinguish between 
them ; this derangement is mostly owing to a disregard of 
hygiene, and infraction of the organic laws, by the fe- 
male. Before proceeding to the consideration of this con- 
dition, for the purpose of imparting progressive knowledge, 
we shall notice the hygiene of marriage, and certain mal- 
formations and conditions, which, when they are present, 
prevent altogether, or render the occurrence of, gestation 
extremely perilous to the female. 

We shall, then, proceed to point out certain hygienic 
rules relative to the normal union of the sexes, which will 
be the substance of what C. L'Isere says upon the subject, 
an observance of which, is of immense consequence to the 
human family ; this, with malformation oj the pelvis and 
genital organs of the female will form subjects for the first 
two chapters. We shall afterwards, and before speaking 
of pregnancy, treat of impotence and sterility. The dis- 
eases of pregnancy wiL be included in a separate section. 



SECTION I. 

PHYSIOLOGY OF PREGNANCY. 



CHAPTER I. 

HYGIENIC RULES FOR THE NORMAL UNION OF THE SEXES, 
WITH REMARKS ON VICIOUS CONFORMATIONS OF THE FE- 
MALE GENITALS, WHICH PROHIBIT THE APPROACH OF THE 
SEXES. 

If, on the one hand, the condition of virginity, in our 
civil institutions, is a state of violence against the impul- 
sions of nature, very different from the free state of the 
young females of animals who are subjected, at the period 
of their loves, to the yoke of passion ; and if, on the other 
hand, it is generally admitted that marriage is the state 
most favorable to the happiness, well-being, and health of 
man, it is important to respond to the call of nature, as 
soon as the complete development and perfect conforma- 
tion of all the organs allow. In the infancy of the world, 
the sexes obeyed in their union only the natural sentiment 
which attracts them towards each other ; but philosophers, 
physicians and legislators, made marriage one of the 
chief objects of their meditations. Seeking to determine 
the more or less advantageous influence which might result 
from it to the people, whose happiness they sought to 
assure, all agreed that the most serious inconveniences 
might flow from the premature union of the two sexes. In 
order to prevent the evil effects of marriage before the full 
development of the constitution, legislators have determin- 
ed its epochs. Lycurgus and Plato fixed it at seventeen 
years for girls, and Aristotle at eighteen. Among the 
Romans, women were authorized by the Poppcean law, 
to marry at the age of twelve years ; lastly, the Athenians, 



268 HYGIENE FOR THE NORMAL UNION OF THE SEXES. 

less scrupulous, permitted marriage as soon as the indi- 
viduals believed themselves fit to fulfill its end. This 
law, fatal to population in general, and especially danger- 
ous for women, accorded with the customs and warlike 
policy of the people of Athens. As it would be both use- 
less and fastidious to«citeall the 'aws and opinions relative 
to marriage, we shall confine ourselves to saying, that the 
period ought to vary with the difference of the place, of 
climate, of people, and with the degree of civilization — 
since these several circumstances may hasten or retard the 
first appearance of the menses and the age of complete 
nubility. 

The French laws, before the Revolution, forbade legal 
union, for girls, before the age of twelve years ; but, by 
the present code, they eannot enter into the conjugal tie 
until they have reached the age of fifteen complete. The 
French legislators have permitted marriage at this early 
period after birth, because they deemed it necessary for 
the interest of good manners, inasmuch as accidental con- 
nections between the sexes might occur at that period, to 
leave some means by which to repair a fault, and legiti- 
matise children, who, but for this provision, would have a 
false, and unhappy position in society. Moreover, if it 
be recollected that marriage is the most effectual means of 
removing the evils resulting from the violent desires which 
are often excited in young girls, at an early period, by 
the education they received, and by the prevailing cus- 
toms of society, it will be agreed, undoubtedly, that the 
civil code has been digested with the utmost wisdom. 
Nevertheless, regarding woman only in her physiological 
aspect, we think that from eighteen to twenty-jive is the age 
at which women may marry most advantageously for them- 
selves and for their children. Besides, there is a rule by 
which we may always guide ourselves, which is to place 
at least two years between the time of marriage and tlie 
first appearance of the menses. 

It is rare for the constitution to have acquired, before 
this period, the development necessary for the reproduc- 
tion of the species. M. Lachaise, in his Hygiene, re- 
marks : " If the indispensable process of nature, occupied 
with the completion of its organization, are broken in 



HYGIENE FOE THE NORMAL UNION OF THE SEXES. 269 

upon by the premature enjoyments oF marriage, the 
female will be exposed to a thousand risks, in her new 
position ; — become pregnant, she will be unable to support, 
without the greatest difficulty, and at the expense of her 
health, the innumerable and unavoidable inconveniences 
of that condition ; she will be liable to abortions and he- 
morrhages, and the pangs of childbirth may cost her, per- 
haps, her life ; — become the mother of delicate and siokly 
infants, she will pass her youth in uneasiness and tears ; 
give to the offspring of her love an impoverished milk ; 
yield herself in order to rear them, to cares and watch- 
ings beyond her strength ; hasten for them the approach 
of old age, and tear herself, perhaps, from life at a period 
when she is ordinarily strongest and most active." Though 
premature marriages are not invariably followed by such 
fatal consequences, we may say that they always influ- 
ence more or less, the physical and moral condition, and 
hasten the termination, already too precipitate, of youth 
and beauty. 

In women who are well formed and fully developed, 
the first enjoyments generally produce a favorable impres- 
won upon the constitution ; never heless, it sometimes 
happens that the genital organs become the seat of inflam- 
mation, or that newly-married persons suffer from some 
spasmodic disorders which readily yield to absolute repose 
of the organs, to the employment of general baths, seda- 
tive drinks, narcotic and emollent enemeta and lotions ; 
lastly, to general depletion, where the pulse is full and 
the reaction very violent. 

While a moderate enjoyment in the marital embrace 
generally produces useful effects, when too often repeated 
it occasions lassitude, feebleness and general depression ; 
the beauty is soon destroyed, the grace and freshness of 
youth are soon withered ; finally, when the abuse of coi- 
tus is kept up, it may determine inflammations and ulcera* 
tions of the vagina and uterus, leucorrhea, uterine hemor«* 
rhage, disorders of the digestive and nervous apparatus, 
acute and chronic gastritis, attacks of hysteria and nym- 
phomania, feebleness of all the senses, loss of memory, 
stupidity, moral inferiority, caries of the vertebrae, aneu- 
13 



270 HYGIENE FOR THE FORMAL UNION OF THE SEXES. 

risms, especially of the heart, pulmonary consumption, 
marasmus and death. 

Under all circumstances, young married persons ought 
to proportion their pleasures to their forces, and should 
recollect that the first conjugal approaches require certain 
cares and precautions, the forgetfulness of which might 
lead to the most unhappy results. When the consumma- 
tion, of the marriage meets with too great resistance, 
especially when there is disproportion between the organs, 
the husband, young, full of vigor, and sometimes inexpe- 
rienced, instead of abandoning himself to' all His trans- 
ports, should seek to overcome the obstacles with care and 
circumspection. In general, the difficulties which the 
first essays of marriage present, are least during the 
period of the menses and for some days afterwards. We 
may remark, also, that the use of unctuous substances of 
emollient fomentations, and of general baths, and that the 
effusion of blood, even, which generally follows the first 
attempts may determine a useful relaxation in cases of 
difficulty. Nevertheless, if too great a resistance should 
be met with, far from making violent efforts that might 
endanger the life of the female, some unnatural conforma- 
tion ought to be suspected, and the assistance of a surgeon 
be envoked against an obstacle, which he, alone, can sur- 
mount without risk. 

As conception is the most natural consequence of the 
marital connexion, and though the reproduction of the 
species is the chief end of the institution of marriage, 
they are yet certain circumstances, which, however im- 
perious the senses, and however powerful the laws of the 
social condition, should be held as authoritative enough to 
forbid the sexual approach, as regards some women, in 
whom it threatens to become the fruitful source of dan- 
gerous diseases, and often, indeed, the cause of death 
itself. Among the number of deformities which contra- 
indicate marriage for such persons, we should place in the 
first class those which are capable of preventing the act 
of generation, or that of parturition, such as insufficient 
capacity of the pelvis, or absence of the vagina. The 
first-named fault of conformation would place the woman 
under the cruel alternative of undergoing the Caesarian 



DEFORMITY OF THE PELVIS. 271 

operation, or that for the section of the symphysis pubis ; 
or, at least, of seeing her offspring sacrificed and extract- 
ed piecemeal. 

In general, we may presume that there is vicious con- 
formation of the pelvic cavity, whenever we find a curve 
in the vertebral column, which allows the last lumbar 
vertebra to sink in towards the posterior and upper part of 
he ] elvis ; where the haunch bones are not very appa- 
eh\ and are very much elevated on one side ; where the 
nigl^ are closely approximated to each other, and, in fine, 
whoie a curve in the long bones and swelling of their 
articular extremities indicate a general rachitic condi- 
tion. It is true, however, that we have seen some hor- 
ribly deformed women, with a well formed pelvis, and 
lyin^-in very easily ; while there are others, who, with all 
the appearance of a regular conformation, cannot bring 
their children into the world, and almost inevitably perish, 
because they have the superior strait of the pelvis with 
an antero-posterior diameter of not more than two inches. 
Parents who should suspect the existence of such pelvic 
deformity in their children, ought never to consent to their 
marriage, without first taking the opinion of a capable 
physician ; for though an examination into the facts of 
such a case gives a shock to the modesty of the female, 
such a sentiment ought not to be put in balance against 
the life both of a mother and her child. 

Among the disorders that ought to be admitted as obsta- 
cles to a legal union, we place, pulmonary consumption, 
aneurism of the large arterial trunks, idiocy, insanity, and 
even epilepsy, where that disease continues after the age 
of puberty. 



CHAPTER II. 

YICIOUS OR ABNORMAL CONFORMATION OF THE FEMALE PEL- 
VIS, AND GENITAL APPARATUS CAUSES AND TREATMENT. 

The pelvis as well as most or all of the femalo genital 
organs are subject to malformation, either congenital or 



272 DEFORMITY OF THE PELVIS. 

accidental. And, although some of these are beyond tne 
resources of art, as absence of the womb, vagina, ova- 
ries, etc., there are many susceptible of remedy ; as for 
example, cohesion of the labia and nymphae, obliteration 
and narrowness of the vagina, etc. 



DEFORMITY OF THE PELVIS. 

By deformation of the pelvis is understood, when it is 
sufficiently altered, either in its form or dimensions, to 
render delivery difficult, dangerous, or impossible. All 
deformities of this cavity, are usually classed under three 
heads ; excess of amplitude , narrowness, and faulty direc- 
tion of its axes. 

It would seem before examination that a very large pel- 
vis ought to be rather an advantage to child-bearing, than 
the contrary : but observation proves that this is not the 
case. This conformation, besides conducing to displace- 
ment of the uterus in almost any direction, also favors the 
descent of the womb and consequently prompt termination 
of labor, exposing the woman to those accidents that fol- 
low rapid delivery — the principal of which are inversion 
of the uterus and hemorrage. 

There may be simply a want of amplitude, or, which is 
much more common and dangerous, partial narrowness, 
changing the diameters of the inlet, cavity, or outlet ; or 
several of these deformities may be conjoined. (See the 
normal pelvis at page 20.) These different abnormal con- 
formations give to the pelvis a great variety of forms, 
which our limited space will not permit us to dwell upon. 

These various faults of conformation change more. or 
less the planes and axes of the pelvis. The most com- 
mon deformity of this kind, is projection of the sacrum to- 
wards the pubis, the hollowness of the lumbar region or 
back, being augmented. 

The effects of all these faulty conformations are, to ren- 
der labor either painful, tedious and difficult, or impossible. 
We should remark that those of the second class, or nar- 
rowness from deformity, are the most embarrassing. As 
we spoke sufficiently in the last chapter of the manner of 
detecting these deformities, and it not coming within our 



DEFORMITY OF THE PELVIS TREATMENT.. 273 

purpose to speak of the modes of "mensuration" of the 
pelvis, we shall pass on to the causes. 

Causes. — Deformities of the pelvis may take their rise 
in childhood, or may be produced after adult age. In the 
former case they are commonly the result of rickets, where 
there is softening of the bones : the child by too much 
standing upon the feet, sitting, or lying upon the back, fa- 
vours that part to give way which is least resistant. The 
action of the powerful muscles which surround the pelvis, 
also, in certain cases, favor the production of this condi- 
tion. In the latter .case, or after the first periods of child- 
hood, these deformities are generally the result of mollities 
ossium, either general or partial, of irregular action of the 
muscles, and of bad attitudes. Young girls, who, for the 
purpose, as they suppose, of obtaining elegance of form by 
increasing the prominence of their hips and the depth of 
the lumbar hollow, keep the head and pelvis thrown strong- 
ly backwards while they project the abdomen and breast 
as far forwards as possible, never think that they run the 
risk of never being able to become mothers, without ex- 
posure to the greatest danger. A diseased hip wearing an 
artificial limb, fractures, etc., also, sometimes give rise to 
this condition. 

The treatment of course consists only in avoiding the 
causes as far as possible, and of avoiding when necessary 
the social relation in which the female exposes herself to 
become pregnant, and consequentty to the Caesarian sec- 
tion, or some other painful operation. Women have not 
been afraid to become pregnant again, after having under- 
gone this formidable operation. Dr. Velpean says, in 
speaking of the grounds of opposition to pelvic mensura- 
tion : is it really the attraction of pleasure that always in- 
duces them to yield to the brutal husband that the law has 
given them ? Is it fair to compare a woman who fears 
above all things to lose the affections of a man to whom 
she is united for life, to a young girl, who, free from all 
entanglements, ought to think first, and above all, of her 
own safety ? 

M 



274 COHESION OF THE LABIA — TREATMENT. 

OCCLUSION AND ABNORMAL CONFORMATION OF THE EXTERNA! 
SEXUAL ORGANS. 

1. Union of the labia is sometimes found to exist in 
female children at birth. When it is complete, nothing iu 
to be seen but a seam, the vagina, clitoris urethra, etc., 
being all enclosed. This condition is announced soon 
after birth, by the crying of the infant, when a fluctuating 
tumor may be detected above the pubes, and there is all 
the symptoms of suppression of the urine ; death will soon 
be the consequence, unless measures be taken for reme- 
dying the difficulty. 

In some cases the cohesion is not complete, and the urethra 
is sufficiently open to give free passage of the urine ; in 
others, the obstruction is such, as only to admit of its escap- 
ing drop by drop. In the former case, it is of no inconve- 
nience till the period of puberty, when it obstructs the flow 
of the menses ; but of this we have already spoken. (See 
Tardy Appearance of the Menses.) 

This condition is not always congenital ; it may be 
occasioned by inflammation, brought on by laborious labor, 
a burn, a wound, or a laceration ; by excessive coitus, and 
finally, in children, by excoriations from acrimony of the 
urine, friction, want of cleanliness, etc. It is said that 
some of the Ethiopian tribes make sure of the virginity of 
the female by uniting the sides of the labia as soon as they 
are born, with silken thread, leaving only sufficient space 
for the natural discharges; when married their lords 
make the necesary section for their restoration. 

Cohesion of the nymphse always accompanies that of 
the labia, but it may exist independently of the latter. 
Its causes and treatment are the same. 

Treatment.— The treatment consists in an operation 
suitable for the restoration of the parts, as nearly as possi- 
ble, to their normal condition. In all cases it should be 
performed as soon as discovered, particularly when the 
cohesion is complete. In infancy, as we have elsewhere 
stated, the knife is not necessary, unless the union be 
firm. But at a more advanced period, the operation must 
be performed by means of a bistoury guided with a direc- 
tor. To prevent reunion, a piece of lint, or a compress 



EXCESSIVE GROWTH OF THE NYMPHS CLITORIS. 275 

spread with cerate, sh3uld be interposed until the cure is 
oomplete. Strict cleanliness must be observed, to assist 
which, recourse should be had to emollient baths and 
lotions, according to circumstances. 

2. Excessive development of the nymphs, which 
we have already adverted to, at page 32, Book I., may- 
arise to such an extent as to interfere with the functions 
of the female, and be a source of inconvenience and pain, 
in consequence of excoriations from friction in walking : 
in such cases their excision is sometimes necessary. 
Many travellers have stated that in several countries of 
the East, this operation is a very common one — being re- 
sorted to by some as a rite, and by others for the purpose 
of preventing a pretended deformity. It has, also, been 
stated, that certain women and men, whose sole business 
it is to excise exuberances of the genitalia, go about the 
streets crying aloud, " Here is a good circumciser /" etc. 
A sharp knife and a pinch of ashes comprise the whole 
apparatus for carrying out this strange custom. 



3. Unnatural growth of the clitoris, as we have 
remarked at page 33, has given rise to the supposed ex- 
istence of hermaphrodites. During the first month of 
uterine life, this organ is much larger than at birth — at 
which time it is still considerable, but is found diminished 
at the age of puberty. In some women, however, it 
attains a much greater development, than is ever found 
in early life. It has, occasionally been found from one 
to six inches in length,* when it may become the source 

* Dr. Harris of Philadelphia has recorded an interesting case of this 
kind, which, for the purpose of illustrating what has been mistaken 
for the fanciful being, known as hermaphrodite, we will give a brief 
abstract of: A child was born in Chester county, Penn., of doubtful 
gander. The gossiping women present, were called to inspect an unusu- 
ally large clitoris, and to decide the infant's sex, when the little stranger 
was pronounced a female, and named Elizabeth. As she advanced in 
years, the clitoris enlarged, and in appearance and size resemdleb, the 
penis masculinus; she also, grew robust, assumed a masculine appear- 
ance, delighted only in the labors of the field and manly sports. At 
eighteen years of age, she was nearly six feet, had moustaches on the 
upper lip, reversed the descision in regard to her sex at birth, and ex- 
changed the female attire for man's apparel, and her name for Rees n 
at the same time threatening summary vengeance against any person 



276 UNNATURAL GROWTH OF THE CLITORIS. 

of disgraceful and disgusting depravity. It is reasonable 
to suppose from the intense sensibility of this part, that it 
is often the cause of unnatural excitement, masturbation, 
etc., leading to the most degrading immorality. 

In the treatment of such enlargements, cooling and 
astringent applications with saline purging should first be 
resorted to — at the same time avoiding exciting food, indo- 
lence, improper associations, sentimental reading, etc. 
When these fail, amputation of the salient organ should 
always be recommended, which is performed without sub- 
sequent inconvenience to the female, and with producing 
very little pain. Thus, it is consoling to reflect, that the 
female may be rid of a djsgusting infirmity, which some- 
times gives rise to uncontrolable depravity, with perfect 
safety. Instances are not wanting, in which, girls have 
been entirely cured of masturbation by this operation, 
which had resisted all other means. In such cases a 
competent surgeon should always be consulted. 

4. Imperforation of toE female urethra is gene- 
rally a consequence of complete cohesion of the labia, but 
exists sometimes by itself, from its being covered by a 
thin and delicate membrane. When its existence is sus- 
pected, no time should be lost in giving relief by punctur- 
ing the membrane,, by means of a suitable instrument. 

When there is a narrow opening through which the 

who should venture from that time to speak of her as a female. She 
now abandoned all female duties, and was employed on a farm, perform- 
ing all the duties of a husbandman. 

She never menstruated : at the age of twenty-five had a very strong 
beard ; was industrious and enterprising, and increased rapidly in wraith, 
by the purchase and sale of farm stock. Being remarkably athletic and 
impetuous in her temper, she was the terror of the whole neighborhood, 
and was always victorious in personal conflicts. 

About this time she purchased a large aud fertile farm, and married a 
woman whose name was Elizabeth. In the marrige state, she manifested 
some affection for her companion, and professed peat enjoyment in con- 
nubial pleasures — the clitoris having now attained the enormuos length 
of six inches. It is needless to say that there could be no offspring; 
indeed, she often said to her companion, "I have no generative power, 
and if you ever become pregnant. I will put you to death." 

This extraordinary female lived until she was upwards of fifty years of 
age, and died in possession of a large estate, which she had accumulated 
by industry and enterprise. She came to an untimely end by arsenic 
administered by the hand of her treacherous companion. 



IMPERF0RAT10N OF THE VAGINA— TREATMENT. 277 

urine escapes with difficulty, it should be overcome by 
the daily use of bougies, beginning with one of a small size. 
When there is occlusion of the urethra through a great 
part of its extent, the bladder must necessarily be punc- 
tured ; if this be too long delayed the child will inevitably 
perish. 

FAULTY CONFORMATION OF THE INTERNAL ORGANS. 

1. Imperforation of the vagina may be congenital, 
or it may arise from accident in after life. It produces 
no inconvenience till the age of puberty arrives, when 
there is great distress, from secretion and accumulation of 
the menses. An imperforate hymen is the most common 
cause ; but sometimes other membranes are formed be- 
neath it; and occasionally the walls of the vagina are 
adherent throughout its whole extent, forming, instead of 
a tube, a solid body. It is sometimes produced by inflam- 
mation in consequence of injuries from childbirth, or 
criminal attempts at abortion. 

At puberty, when the menses accumulate, the symp- 
toms so nearly resemble those of pregnancy, that learned 
physicians have repeatedly pronounced it thus, while, in 
fact, the patient was still a virgin. There is enlargement 
of the abdomen, pain in the back and loins, swelling of the 
breasts, nausea, vomiting, etc. All of these symptoms are 
greatly increased at each menstrual epoch. If relief be 
not obtained, the accumulation becomes enormous, giving 
rise to the most painful and dangerous symptoms — hyste- 
ria, convulsions, etc. If there be absence of the womb or 
ovaria conjoined, with an imperforate vagina, there is no 
menstrual secretion, and consequently no inconvenient 
symptoms. 

Treatment. — When there is an obstructing hymen 
some authors have recommended that it be ruptured by the 
point of the finger ; but very often it will be necessary to 
resort to the knife or trocar for puncturing it. The ope- 
ration should be carefully performed, so as to give the pa- 
tient the advantage of the moral importance attached to the 
hymen. When the walls of the vagina are adherent, their 



278 ABSENCE OF THE INTERNAL GENITAL ORGANS. 

separation requires great care and skill. We have before 
spoken of these subjects ; (see Book I., page 34, and 102.) 

2. Narrowness op the vagina may be congenital or 
arise from various accidental causes. Instances are met 
with in which this organ is barely pervious, being.but a 
few lines in diameter. It, of course, does not admit of the 
uses for which it was designed by nature. This difficul- 
ty may be often overcome by dilating the passage with 
bougies, commencing with a very small size, as we have 
directed at the close of the chapter on Painful Menstrua- 
tion, Book I. 

Narrowness of the vagina does not always prevent con- 
ception, although its effects are extremely embarrassing. 
Several cases are on record in which dilatation was effected 
after a tedious labor, and others wherein the process was 
assisted by incisions. We should remark also, in conclu- 
sion, that this condition always produces difficult and pain- 
ful menstruation,-^-when an examination should be insti- 
tuted, for the purpose of ascertaining the exact nature of 
the difficulty. 



Narrowness and complete closure of the neck of 
the uterus sometimes occur, while the vagina itself may 
be perfectly free from obstruction. It may generally be 
detected by the touchy and the plan of treatment is about 
the same as that directed for the vagina, though more diffi- 
cult, in consequence of its being less easily accessible. 



Obstruction of the Fallopian tubes, either complete 
or incomplete is sometimes met with after death. It may 
be congenital, but is more often accidental from inflamma- 
tion. This affection is beyond the reach of art. 

3. Absence and malformation of the internal or- 
gans. — The records of medicine contain no instance of the 
complete and simultaneous absence of all the internal gen- 
ital organs. In extremely rare cases, one ovary only with 
its tube has been found, and half of a womb. Both ovaries 
have been found absent, while the remainder of the organs 
remained in a natural condition. 



ABSENCE OF THE INTERNAL GENITAL ORGANS. 270 

The womb alone has been found absent and also coinci- 
dently with absence of the vagina, with a perfectly natural 
appearance of the external genitals. In such cases of 
course there is no menstrual secretion ; but when the uterus 
and its appendages are present, with absence of the vagina, 
the secretion may take place, and give rise to all of those 
symptoms mentioned when speaking of Imperf oration of the 
Vagina. Under such circumstances relief has been af- 
forded by forming an artificial canal between the rectum 
and bladder. These cases are extremely rare. The womb 
has also been found divided into two equal or unequal 
parts, either partially or entirely— constituting what has 
been called a double uterus. 

The vagina has been met with double — that is, divided 
by a septum into two canals ; and only one third of its 
usual length and diameter ; it has been also wholly want- 
ing, as we have before intimated, with the bladder and 
urethra in immediate contact with the rectum. In ex- 
tremely rare instances, an unnatural vagina has opened 
into the bladder, the urethra, the rectum, and externally 
upon the anterior surface of the abdomen. These defor- 
mities are not incompatible with health, and may remain 
unknown till the menstrual secretion takes place, and is 
discharged by these unnatural routes. 

It has long been observed that those females who have 
an absence of the ovaria, whether it be combined with ab- 
sence of the uterus or not, approach in character to the 
male ; the delicacy of mind and body is exchanged for 
the firmness, and an approach to the physical peculiarities 
of the male. They have very small breasts, hard features, 
more or less beard, and are fond of manly sports and ex- 
ercises. There may be, however, serious faulty confor- 
mations, as absence of the uterus only, or of the vagina, 
or obstructions of the latter named organ, in which there is, 
to every external appearance, perfection of the female 
frame. It would be highly imprudent to say the least, 
for such an individual to contract the marriage relation, 
for which she is wholly unfitted. Every mother should 
know sufficiently of her daughter, and of the existence or 
non-existence of such grave difficulties, to avoid an event 



280 STERILITY AND IMPOTENCE CAUSES. 

which is sure to bring only disappointment and misery to 
the bosom not only of the female but also to her partner. 
In all cases marriage should be postponed until after the 
eruption of the menses ; or, at least, until a proper inquiry 
and examination shall have decided in regard to the fitness 
of the subject to assume the responsible duties and func- 
tions of the marital relations. 



CHAPTER III. 

STERILITY AND IMPOTENCE CAUSES AND TREATMENT. 

Woman, before the period of puberty, and after the 
change of life, according to the design of nature, is inca- 
pable of fecundation ; there may be some exceptions to thi3 
rule, which are to be regarded only as departures from the 
normal condition. During suckling also, when the vital 
forces are concentrated upon the organ of lactation, the fe- 
male is generally found to be barren, particularly for the 
first few months following the birth of the child ;— -though 
the exceptions here are more numerous than in the former 
case. But there are many diseases and abnormal circum- 
stances, which, when they occur, independently of these 
circumstances, render the female sterile during the child- 
bearing period. 

By sterility, is understood an incapacity for fecundation, 
notwithstanding there is nothing to prohibit copulation, 
which is, apparently, accompanied with all the conditions 
necessary for conception ; — depending, probably, upon 
lorpor or weakness, or absence of seme of the internal 
organs. 

Impotence, on the other hand, indicates a want of power, 
or inability for copulation, either depending upon some 
physical impediment or abnormal conformation, or upon 
weakness of the generative apparatus. 

Causes. — Among the causes of impotence may be enu- 
merated absence of the vagina, or its accidental oblitera- 
tion, from inflammation, narrowing of that canal, from con- 
traction or a tumor, etc. ; cohesion of the labia or nymphse; 



STERILITY AND IMPOTENCE CAUSES. 281 

too great firmness of the hymen, or the existence of any 
other membrane in the vagina ; excessive enlargement of 
the clitoris; prolapsus of the uterus or vagina, etc., many 
of which, as has been seen in the preceding chapter and 
elsewhere, are amenable to treatment. 

The causes of sterility are often very obscure : it is 
probable that they are often connected with some abnor- 
mal condition of the ovaria — either their absence, want of 
development, or with diseases of these organs, producing 
degeneration of structure ; absence or obliteration of the 
Fallopian tubes ; absence, occlusion, curvature, or chronic 
inflammation of the womb ; and other malformations and 
disorders of the genitalia which give few or no signs of their 
existence during life. Diseases of the uterus, such as 
cancer, polypus, displacement, dropsy, etc., act sometimes, 
but not 'invariably, as causes of sterility, as we have re- 
marked when treating of those various disorders. 

Dysmenorrhea, menorrhagia and profuse leucorrhea, par- 
ticularly that species which affects the glands of the neck 
of the uterus ; impermeability of the neck ; suppression or 
absence of the menses, etc., are also frequent causes. 
The latter, or absence of the menses, has been regarded 
as a sure sign of barrenness ; but it is well - known that 
there are exceptions. Notwithstanding, the presence of the 
menstrual discharge has always properly been regarded 
as the most certain indication of an ability for fecundation. 

Sterility has been observed to be more common in hot 
and very cold countries, than in temperate latitudes. De- 
bility, either of the generative powers alone, or of the whole 
system from any cause, and particularly when induced by 
masturbation and an abuse of venereal pleasures, is a com- 
mon cause in all climates, but more especially in warm 
ones, where there is a greater excitability of temperament. 
It is well known that the whole class of prostitutes are bar- 
ren from this cause. Also absence of voluptuous desires, 
from this cause, or from an approach in resemblance of 
the female to the male ; such as is observed in women 
with small breasts, and who have a general masculine 
appearance, strong hoarse voices, and brown skins, with 
more or less beard, and hair in unusual places for the sex ; 



282 STERILITY AND IMPOTENCE CAUSES. 

an excessive embonpoint, and finally, too frequently re- 
peated and too violent transports. 

Unsuitable marriages, as to disparity of age, as well as 
to a similarity of temperament in the parties, often prove 
unfruitful. It frequently happens that a young couple 
who are both very vigorpus and passionate, will have no 
children ; also that a couple who are both lymphatic, cold, 
and one where both are highly intellectual, are sterile. 
This seems to be wisely ordered in nature for the purpose 
of preventing parents from transmitting to their offspring 
undesirable or monstrous constitutions. Such connections 
after having been broken asunder by divorcement, and 
each party made new engagements, have repeatedly prov- 
ed that the fault was neither in the one or the other ; for 
they have both had children by being united to their op- 
posites in temperament. This was the case with Napole- 
on Buonaparte and Josephine, who, as Larrey has re- 
marked, were both too highly intellectual to produce the 
necessary excitement — thus the coldness of each repulsed 
the other ; yet when separate, they gave proof that the de- 
ficiency was in neither, but only in their unfitness for each 
ojher. It is known that Catherine de Medicis brought 
forth the first one of her ten children, after having been 
married ten years to her husband, Henry II. ; also, that 
Anne of Austria gave birth to Louis XIV., after twenty- 
two years of barrenness. 

It has been observed in Europe that fewer children are 
born in Provinces where the inhabitants are poor, idle, 
weakly and wretched ; also, generally, that in years of 
famine or scarcity, public calamities, epidemics, fasts and 
privations, the number of births are sensibly diminished. 
On the contrary, it is known that many more children are 
born in a fine and healthy climate ; in countries where the 
arts and sciences, industry and commerce flourish ; where 
the earth is fertile and the air salubrious. It is recorded 
by Dr. Hecker that after the rage of the great epidemic of 
the fourteenth century, called the " Black Plague," a 
greater fecundity of women was every where remarkable. 
During the three years of its prevalence, the mortality 
is computed at 25,000,000 souls. Those women who live 
in a state of opulence, are habituated to a too stimulating 



STERILITY AND IMPOTENCE CAUSES. 233 

diet, abuse the use of stimulants, as wine, spirits, tobacco, 
etc., are very often unfruitful ; — this extreme being quite 
as unfavorable as the opposite — that is, where there is en- 
tire destitution. 

Notwithstanding all these occasional causes, it frequent- 
ly happens that there are no certain signs by which to 
ascertain the cause, or to distinguish a barren from a 
fruitful woman. The late discoveries, however, concern- 
ing the development of the ovaria, mentioned under the 
subject menstruation, enable us much better to understand 
such obscure cases. It is very probable that the ovaria of 
some women are not properly developed ; that though they 
may menstruate largely, these essential organs are not 
normally evolved ; or, that being ripened, the ovae are 
almost immediately discharged with the menses, on ac-" 
count of some organic deficiency of power. M. Pouchet 
is of opinion that the precise time wherein fecundation is 
impossible, can be correctly indicated, as there is a time 
between the periods of the menses when no developed 
ovum will remain. The question is not settled whether 
the rupture of the Graafian vesicle and escape o£ the 
ovum takes place antecedent to, in the midst of, or at the 
close of the menstrual flow ; and it is very probable that 
this period is variable, and can never be fixed upon. It 
has been supposed that conception is more likely to occur 
immediately after the menstrual flow, but this point does 
not seem to be sufficiently established ; however, as there 
is more activity in the genital apparatus about this period, 
qvJ the mouth of the uterus is more open, and as the 
ovum may not be discharged with the menses, it is proba- 
ble that conception is more liable to occur immediately 
before, just after the discharge has disappeared, or several 
days after it has ceased. 

Let us remark in conclusion, that too early marriages, 
and self abuse or masturbation, are frequent causes of 
sterility, as also are marriages against the inclination ; 
and although voluptuous desire on the part of the female 
very much favors conception, perfect indifference is not 
absolutely incompatible with that event ; finally, intense 
mental application, depressing emotions, certain humid 



284 STERILITY AND IMPOTENCE TREATMENT. 

localities and states of the weather, are found to exercise 
a very unfavorable influence. 

Treatment. — When barrenness depends upon faulty 
conformation, displacement or disease of the womb, we 
may hope to obviate it, as we have seen in the preceding 
and other chapters of this work, by operations, or by medi- 
cal treatment appropriate to the disease : as we have 
treated of all these conditions in preceding pages, and as 
the cure is often evident from the various causes just 
pointed out, an extended notice of the treatment here can- 
not be necessary. 

We should remark in the onset, for the purpose of shield- 
ing the reader from imposition, that there is no greater 
fraud practiced upon the credulity of the public, than that 
of blazoning forth specifics for the cure of barrenness. 
The ■" Lucina Cordials," "Tinctures," etc., so absurdly 
sold for this purpose, it is well known, are composed of a 
few ingredients, which, although they act as- a temporary 
irritant, in the end serve to prostrate still more those very 
powers designed to be restored. Cantharides and phos- 
phorus can rarely or never be employed with advantage 
in this condition, under the most favorable circumstances. 

When there is indifference to the joys of wedlock, from 
a lymphatic and cold constitution, or from debility, gener- 
al or partial, the cause, if known, must first be suspended ; 
then resort should be had to a generous diet, tonic baths 
and drinks, as sea or fresh cold water bathing, and min- 
eral spring waters ; the diet should be substantial, as 
black meats, eggs, oysters, jellies, with a cautious use of 
good wine, chocolate, sage, mushrooms, celery, vanilla, 
and the various nourishing and exciting articles. Finally, 
where there is approach to impotency from loss of power 
on the part of the female, might be recommended in addi- 
tion, the reading of erotic romances, and frequentaion of 
the ball-room and theatre — all to be timely employed so 
as to excite without debilitating. On the other hand, if 
sterility depends upon excessive ardor and voluptuous- 
ness, as frequently happens in newly married individuals, 
a directly opposite course should be pursued, as cooling 
drinks, cold milk, light, emollient food, cold bathing, long 
walks, labor, etc., with an abstinence from all indulgen- 



THE ORIGIN OF HUMAN LIFE. 285 

ces. I* 1 of two strong a constitution, recourse n ay be had 
in addition to venesection. 

When it is supposed that barrenness arises from defi- 
ciency of action of the ovaries, electricity may be tried 
with some hope of success, with stimulating lotions and 
frictions to the loins and groins. Where the woman is 
excessively fat, exercise and excitation of the mind as 
well as the body will be useful : as romance reading, the 
internal use of spices, mint, aloes, nutmeg, etc. ; also, 
frictions and stimulating lotions to the groins, thighs and 
loins. In all cases we should recommend the sexual 
approach just before and after the menstrual flow, with 
proper intervals of rest. In conclusion, we should remark 
that when sterility is supposed to depend upon excessive 
sensual gratification, the parties should moderate their 
desires, either by a temporary separation, or by self con- 
trol. None of the means we have now recommended 
should be expected to produce an immediate change, but 
they should all be timely and continuously applied with 
particular attention to the stomach, bowels, and general 
health ; by following out this course many remarkable 
cures have been nerformed, with little or no aid from 
medicine. 



CHAPTER IV. 

THE ORIGIN OF HUMAN LIFE CONCEPTION. 

The establishment of. the function of menstruation, as 
we remarked when treating of that subject, is the evidence 
that nature has designed and is now ready, to produce an 
independent and living being : or, in other words, that the 
phenomena of that discharge is but a prelude to the more 
important function by which the species is reproduced. 
This is the period, remarks L'Isere, in which woman is 
called to the fulfillment of her most important task. With- 
out ceasing to love, the female arrives at length to a calmer 
and happier state ; having become both wife and parent, 
she finds new duties, she experiences new sentiments ; 
13* 



296 ork;l\ of human life — conception. 

thus, the love of offspring, her conjugal tenderness, the 
education of her children, the management of her domes- 
tics, are the sole objects that attract her regard and fill up 
her happy existence. It is then that she has come to the 
possession of the purest happiness, a happiness connected 
with the love of her family and secured by the moral 
qualities inherent in her sex. 

By the term conception is understood the formation of 
an embryo or the rudiments of a new being. There are 
several other terms used to designate the same event, 
which strictly speaking, are only applicable to different 
stages of the process : as generation, fecundation and re- 
production ; but this distinction, it is not necessary here 
to make. 

Reproduction in the human species constitutes one of 
the most astonishing phenomena of nature. Jt has, in 
every age of the world, engaged the attention of the great- 
est physiologists, and been perseveringly investigated by 
the most celebrated philosophers. Indeed, can anything 
in the universe interest man so much — the only being on 
this earth whose prerogative it is to think — as his own 
origin, and to ascertain its mechanism ? But many of the 
investigations so ably and resolutely conducted have only 
served to show how deep is the mystery that veils the ori- 
gin of life ! 

At different periods of past time have been entertained 
numerous speculations and opinions relative to this mar- 
velous process. Drelincourt, who lived in the seventeenth 
century collected from the writings of his predecessors 
two hundred and sixty -two " groundless Iiypotlieses" con- 
cerning generation ; and it is certain, observes Biumen- 
bach, that Drelincourt 's own theory formed the two hund- 
red and sixty-third ! Most of these theories may be divid- 
ed, according as the germs were supposed to proceed from 
the male or female parent, into classes : first, exclusively 
from the male, which is the theory of the Spermatists ; 
secon d, exclusively from the female, which is that of the 
Ovists ; third, from a union of the male and female germs, 
which is the theory of Syngenesis. Other modifications of 
these classes of theories at a later day give us that ©f Evo- 



ORIGIN OF HUMAN LIFE CONCEPTION. 287 

lution, or the supposition that the germs, which are sub- 
sequertly unfolded, already exist perfectly formed in the 
female ; and the theory of Epigenesis, which assumes thai 
the seed of the two sexes unite in the womb upon chemi- 
cal principles, mutually attracting and combining with 
each other. Without stopping to dwell upon these theories, 
many of which are exceedingly curious and interesting, 
we should remark that that of absorption has also more re- 
cently been advocated ; this theory maintains that the 
seminal fluid of the male is absorbed from the vagina, 
carried into the circulation, and is subsequently deposited 
in the ovaria impregnating one or more of the ova. Last- 
ly, the theory which has more recently and universally 
obtained, and which is still believed by those who have 
not received the new doctrine, is as follows : the semen of 
the male upon being deposited in the vagina, passes 
through the uterus and one of the Fallopian tubes, and is 
thrown upon the ovaria by its fimbriated extremity, when 
impregnation takes place ; — in about one week afterwards 
(by this time the ovum being increased in size) the fim- 
bria seizes the egg or product of conception, and conveys 
it along the tube into the cavity of the uterus, where its 
growth takes place. 

Our limited space not allowing us to discuss the plausi- 
bility or unplausibility of this theory, we shall satisfy 
ourselves by stating that the latter approaches nearer the 
truth than most of the preceding opinions, and that, 
though no one of them is wholly destitute of foundation, 
all have recently been superceded by a positive theory, 
founded upon close observation, multiplied researches and 
experiments, embracing all the preceding, and the truth 
of which is not doubted by any one who has given it an 
examination. These observations, which are still pro- 
gressing, were made by M. Gendrin, and M. Negrier of 
France, Raciborski of Germany, and Robert Lee of Lon- 
don ; we have before spoken of them, when treating of 
menstruation, by which that phenomena is satisfactorily 
explained. (See the Physiology of Menstruation, Chap. 
III., Part HI., Book I.) ' 

M. Pouchet in his Theorie Positive de la Fecondation 
des Mammiferes, etc., Paris — lays down certain funda- 



288 ORIGIN OF HUMAN LIFE CONCEPTION. 

mental physiological laws, concerning generation, an addi. 
tion to which is made by Dr. Meigs, as follows : 

Law I. There is no exception in favor of the human 
race ; the phenomena of human generation obey laws anala* 
gous to those of the mammalia. 

Law II. In all animals, generation is effected by means 
of ova: some inferior creatures only furnish exceptions 
to this law. 

Law III. In all the animal series, ovula pre-exist to 
fecundation. 

Law IV. Physical obstacles prevent the seminal fluid 
from coming into contact with the ovula while within the 
Graafian vesicle. 

Law V. In the entire series of animals, the ovary incon- 
tesfibly emits ova independently of fecundation. 

Law VI. In all animals, the ovary emits ova at deter- 
minate epochs, connected with a periodical sur-excitement 
of the genital organs. 

Law VII. Fecundation never takes place in a mammal, 
except where the emission of ova coincides with the pre- 
sence of the menstrual discharge. 

Law VIII. The emission of the menstrual discharge in 
women corresponds with the phenomena of excitation ob- 
servable in the mammalia during the rut of the zoological 
species, and particularly in the females of the mammalia. 

Law IX. Fecundation has a constant relation to the 
discharge of the menses. It is, moreover, easy to point 
put the inter-menstrual period, wherein conception is 
physically impossible; and also that wherein it is prob- 
able. 

Law X. There are certainly no ovarian pregnancies, 
properly so called. 

Additional Physiological Laws, by Meigs. 

Law I. Fecundation in mammals, when normal, occurs 
in the wjmb. 

Law II. Abdominal and tubal pregnancy do not prove 
that fecundation takes place in the ovary, nor that this is 
what determines the emission of the menses. 

Law III. The Fallopian tubes do not normally con- 
tract, except from the interior towards the exterior, for the 
transmission of the ovum to the uterus. 



ORIGIN OF HUMAN LIFE — CONCEPTION. 259 

The conclusion, from the foregoing, is evident : con- 
ception takes place in the human female in the same man- 
ner as it is observed. to occur in the females of most ani- 
mals, particularly the mammalia order. 

The ovaria of the female, when fully developed at 
adult age, contain a large number of vesicles or eggs. 
They were formerly supposed to be only ten or fifteen in 
number, which were contained in " Graafian vesicles/' ' 
and that one of these escaped at each impregnation. But 
it is now ascertained that they are very numerous — in 
fact, that the ovaria is nearly composed of them. As long 
as they remain imbeded in their primitive condition, they 
are very minute in size. But one or more of them at a 
time, is continually being ripened, when it attains about 
the size of a pirns head ; this occurs monthly, and its dis- 
charge takes place giving rise, as we have elsewhere re- 
marked, to menstruation. Or, if a vesicle be ripe, it is 
liable to burst every time the sexual congress takes place, 
when the ovum which it contains is taken up by the fim- 
bria of the tube, which at this time is erected, and is car- 
ried into the uterus, and escapes through the vagina, un- 
less it meet in its passage through the uterus some of the 
seminal fluid of the male. If this latter occur it becomes 
impregnated and is retained ; thus we have the whole pro- 
cess of conception. The time occupied in its passage is 
supposed to be about seven days ; though of this- we are 
not certain, and some believe that the ovum immediately 
descends and is brought in contact with the semen of the 
male, at the time, or very soon after the marital embrace. 
Its growth now takes place, and the menstrual fluid is re- 
tained for the formation and growth of a membrane to en- 
velop the child, as will be explained hereafter. If, by any 
irregularity, two vesicles be detatched, twins is the re- 
sult ; if three, triplets, and so on. 

Before closing this chapter it may be well to take a 
brief view of the principal reason adduced in favor of 
conception taking place in the ovaria instead of the uterus ; 
it is this, that occasionally, the ovum has been retained, 
and its growth taken place, either in the ovary. Fallopian 
tube, or the cavity of the abdomen, arising, as is alleged, 



290 OUIGIN OF HUMAN LIFE CONCEPTION. 

from some interference in the process of nature in carry- 
ing the germ to the cavity of the uterus. If there are 
really any well-authenticated cases of- extra-uterine preg- 
nancy on record, as there appear to be, their occurrence 
must be otherwise explained than has been heretofore at- 
tempted. As most or all (?) of such conceptions have been 
imperfect or diseased, may we not reasonably suppose 
them to be depraved ovse merely, that have been devel- 
oped in, or escaped from the ovaria, during some abnormal 
excitement of the female ? Or, which is quite as reason- 
able as the other, the embryo may have escaped from the 
cavity of the uterus soon after conception had there taken 
place. Or, if the semen of the male has sometimes found 
its way into the tubes, and conception abnormally taken 
place, it may be regarded as an unnatural occurrence. 

Other arguments might be adduced of greater force 
than the preceding to prove the fallacy of ovarian concep- 
tion as a natural process. According to this theory the 
Fallopian tubes must perform a double action ; that of 
carrying the semen to the ovaria, and then of propelling 
the ovse in an opposite direction, to the uterus — thus not 
only performing a double action, but two directly opposite 
actions. According to some experiments mentioned in the 
Medical and Physical Journal, vol. ix., p. 36, it appears 
that females of an erotic temperament, and who indulge in 
lascivious practices, may have something similar to con- 
ception, an escape of ovse, while in a virgin state withou 
ever having known the sexual congress. Several instan 
ces are recorded in which hair, teeth and bones have been 
discovered in young women, who there was the strong- 
est reason to believe had had no sexual commerce with 
men! 

Finally, we should remark, that after conception has 
taken place, the mouths of the uterus and Fallopian tubes 
become closed by the formation of the deciduary membrane, 
leaving a corpus luteum in the ovaria in place of the de- 
tached egg — which is larger and more permanent when 
the expulsion of the ovule is followed by conception, than 
that which happens at the ordinary menstrual period. 



CHAPTER V. 

THE ORIGIN OF HUMAN LIFE PREGNANCY OR TJTERO-GES- 

TATION. 

We are greatly indebted to recent discoveries for infor- 
mation concerning the primitive development of the em- 
bryo : there is probably no other department of physiology 
which has been so remarkably enriched by modern inves- 
tigations as this. All these researches tend to establish 
the fact that the early development of the human embryo 
takes place upon a plan analagous to that of animals 
much lower in the scale of formation than man. 

At first, the ovum exists in the uterus as a small mem- 
braneous egg, filled with a drop of transparent fluid known 
as the vitellum. Its sides are composed of two delicate 
membranes, the outer one of which is called the chorion, 
and the inner one the amnion. The deciduary membrane 
which we adverted to in the last chapter, is semi-fluid and 
opaque, being secreted immediately after conception takes 
place, and lines the whole uterine cavity. When the 
ovum arrives at the extremity of the tube, it finds the ori- 
fice closed by this material, which- it pushes away as it 
advances into the cavity of the uterus. The ovum is thus 
placed between the side of the womb and the deposit, the 
latter of which it turns back and reflects. That part of 
it which remains in contact with the uterus is called de- 
cidua vera, and that part of it which is pushed away be- 
fore the advancing ovule decidua rejlexa. The latter, at 
first, is just large enough to enclose the ovum which is no 
larger than a small pea ; while the former is as large as 
the whole uterine cavity. In process of time the embryo 
is found to have grown large enough to fill up the whole 
cavity of the womb ; and as it always carries the reflect- 
ed part of the decidua along with it, it follows that at last 
the two are brought into close contact, and from the pres 
sure become completely glued into one. 



292 ORIGIN OF HUMAN LIFE — PREGNANCY. 

The ovum, upon passing into the uterus, generally at- 
taches itself to that organ at a point near the tube by 
which it entered ; but in some instances it becomes moved 
to the fundus, or falls down to the neck, attaching itself 
there ; but wherever it happens to fix itself there is the 
seat of the placenta. The ovum, as has been remarked, 
during the earlier period of pregnancy, lies between the 
deciduary membrane and the uterus, with the chorion in 
contact with its naked surface. At the end of the fourth 
or sixth week the entire surface of the chorion is found to 
be furnished with numerous villi by which it is attached 
to the uterus, ultimately forming the placenta or after- 
birth. 

The following account of the progressive development 
of the foetus, is from Dr. Severn, of London : Impregna- 
tion having taken place, and the ovum conveyed to the in- 
terior of the uterus, its presence may be demonstrated as 
early as the eighth day, when a mucilaginous semi-trans- 
parent drop will be found adherent to the interior of the 
uterus, generally towards its fundus. 

At the twelfth or thirteenth day, it is increased in size, 
and forms a vesicle filled with a turbid, flocculent fluid, 
in the centre of which will be seen a dark spot, the punc- 
tum saliens, or heart of the foetus. 

At the twenty-first day, the embryo is increased to the 
size of a large ant. 

At the thirtieth day, it resembles in size and figure a 
maggot, curled up. At this time, the budding projec- 
tions of the limbs are visible, but their shape is not de- 
fined. 

At six weeks, the size of the foetus is about that of a 
bee ; the clavicles, scapulae, and other bones, are tracea- 
ble ; the limbs are not yet formed, but are still rounded 
prominences, not having acquired their relative length, or 
definite shape. The nose, the eyes, and the mouth, are 
distinctly visible, and the head is larger than the rest of 
the body. 

At two months, the various parts are so much developed 
that we can sometimes decide upon the sex; the features 
are enlarged ; the heart, and the course of the larger ves* 
seis, can be traced. 






ORIGIN OF HUMAN LIFE PREGNANCY. 293 

At three months, the foetus is still further developed : 
its length is three inches, and the genital organs are suffi- 
ciently formed to enable us to distinguish its sex. The 
liver is large in proportion to the other abdominal viscera, 
the lungs small, the bones of the extremities are forming, 
as well as those of the head and spine. 

At four months, the parts are all progressively increas- 
ed, and the length of the foetus is rather more than five 
inches ; a small quantity of meconium is found within the 
intestines, and the movements of the foetus are felt by the 
mother, although very feebly and indistinctly. 

At five months, its length is from six to seven inches, the 
nails are beginning to be formed, the muscles are tracea- 
ble, and the mother perceives that its movements are grow- 
ing gradually stronger. 

At six months, it is from eight to nine inches in length, 
meconium is found throughout the wiiole of the intestinal 
canal ; and if an abortion takes place, the child is some- 
times born alive, but seldom breathes more than a few 
minutes. 

At seven months, it is between eleven and twelve inches 
long ; and if now expelled, it is called a premature birth, 
and the child is capable of being reared. 

At eight months, it measures from fourteen to fifteen 
inches. 

At nine months, it is from eighteen to twenty-two or 
twenty-three inches in length. 

The increase in the size of the womb commences at the 
fundus, immediately after the descent of the ovum. The 
organ, during the first four months, remains in the cavity 
of the pelvis ; after which time it begins to rise, and at 
nbout the fifth month reaches midway between the pubes 
and umbilicus or navel, and gives a fulness to the lower 
i>art of the abdomen ; at the end of the sixth month it 
reaches the umbilicus, which it protrudes ; it continues to 
ascend, and during the seventh month arrives midway 
between the navel and ensiform cartilage of the sternum ; 
at the end of the eighth month it reaches the ensiform 
cartilage, fills the abdomen, pushing the intestines up- 
wards and backwards, and often interferes with the func- 
tion of respiration : during the ninth month instead of 
14 



294 ORIGIN OF HUMAN LIFE FRETJNANCT. 

ascending, it increases somewhat in size and becomes a 
little lower than previously. During the first three 
months,' the mouth of the uterus is lower in the pelvis, 
and directed a little more forwards than usual ; when the 
uterus rises above the brim of the pelvis it is directed 
backwards ; at the sixth month it is said to lose one-fourth 
of its length; at the seventh, one-half; at the e-'ghth, 
three-fourths ; and at the ninth, it is obliterated, so that 
upon examination the finger comes in contact with the 
rounded lower end of the uterus. 

The Placenta or after birth, (see page fronting Book 
II.) is a vascular, spongy mass, of a circular form, and 
generally measures about six inches in diameter, though 
its form and size vary in different subjects. It is an inch 
or more in thickness in the middle, and becomes gradu- 
ally thinner towards the edges. Its outer surface is un- 
even and adheres to the lining membrane of the uterus 
, from which it receives blood for the nourishment of the 
child, which is transmitted by the umbilical vein. Its 
inner surface is smooth, excepting the slight eminences 
formed by the bloodvessels, and is covered by the same 
membranes, the amnion and chorion, which envelope the 
foetus and umbilical cord. It consists essentially of ar- 
teries and veins connected by cellular substance, and is 
formed from the chorion. As soon as the ovum reaches 
the uterus, the chorion being in contact with that or- 
gan, begins to give out villi which increase relatively 
with the growth of the embryo till they become blood ves- 
sels and form the substance of the placenta as above re- 
marked. The use of this organ is to form a reservoir of 
blood for the nourishment of the child. There is gene- 
rally a placenta for each child, but not invariably. 

The umbilical cord or navel string, (see page fronting 
Book II.) consists of two arteries and one vein which con- 
nect the foetus to the placenta, carrying blood for the 
nourishment of the former. Its length though variable, is 
generally from one and a half to two feet. Cases are 
recorded in which it was four and six feet, and others 
in which it was only a few inches in length : but these 
are extremely rare. It is sometimes thicker and some- 



ORIGIN OF HUMAN LIFE PREGNANCY. 295 

times more slender, but generally about the size of the 
little finger. The three vessels of which it is com- 
posed are lengthened continuations of the villosities which 
are given out by the ovum upon its reaching the uterus. 
The vein commences in the placenta by numerous branch- 
es, and passes into the circulation of the child through the 
navel. The two arteries pass from the hypogastric arte- 
ries of the child, through the naval to the placenta, which 
ihey penetrate. These vessels are inclosed within their 
covering, and twisted around each other. If by any ac- 
cident the cord is severed, the foetus dies. Two cords 
have been met with, connected with one placenta, and vice 
versa. In other instances the vessels are supernumerary 
or deficient. When the cord is wholly wanting, the em- 
bryo must of course be imperfect : it is either soon ex- 
pelled, or degenerates into a mole covered frequently by 
hydatids. 

The decidua ry~ membrane consists of two layers, the 
decidua vera, or externa, which is in immediate contact 
with the uterus, and the decidua reflexa, which is next to 
the chorion. At first they are separated by a fluid ; but 
as pregnancy advances, this is absorbed, and the two 
membranes become closely adherent. It is highly vascu- 
lar, receives its blood from the uterine vessels, and seems 
to be designed to assist in the nutrition and preservation 
of the embryo before the elaboration of the placenta. 

The chorion and amnion are thin, transparent mem- 
branes, very much resembling each other, enveloping and 
affordim: coverings for the embrvo. The former is exter- 
rial, and assists the latter in forming a bag of waters, 
which is secreted by the amnion, and called the liquor 
am nii. 

The liquor amnii is a fluid enclosed by the above no- 
ticed membranes, in which the foetus floats. It varies 
much in different subjects ; — in quantity, from a few 
ounces to a gallon, or more; in quality, from a clear, in- 
odorous fluid, to one that is turbid and somewhat putrid. 
It was formerly supposed to be concerned in giving nutri- 
ment to the foetus ; but its real use appears to be, to pro- 
tect the embryo from injuries, and form a soft wedge to 



296 0RTGIN OF HUMAN LTEE PREGNANC7. 

dilate the passages during labor, without injury to the 
child or mother. 

The placenta, cord, and membranes, now described, 
constitute what is called the secundins or after-birth, 
which are products of pregnancy, and of no use after the 
termination of gestation; consequently, they are then 
discharged. 

The fcetal circulation, obviously, has a> different route 
from that which is established at birth after respiration 
takes place. (See the Figure fronting Book II.) The 
stomach of the embryo digests no food, nor do the lungs 
inspire air, neither of w r hich is needed, as the blood that 
nourishes the child is derived directly from the uterus of 
the mother, which is propelled thither by the maternal 
heart, and after circulating through the foetus, is returned 
by the veins through her lungs, for the purpose of being 
purified, to the heart again, to take the same course. The 
child, in fact, may, with propriety, be considered a part of 
the mother's body during its foetal life. 

The umbilical vein of the cord, is formed by the con- 
vergence of innumerable branches in the placenta, which 
unite into one vessel ; this vein passes into the abdomen 
of the child at the navel, distributing blood to the vessels 
of the liver, and connects by the ductus venosus, directly 
with the vena cava inferior. The latter, also receives the 
blood from the liver by the vena porta, and transmits the 
whole to the right auricle of the heart, which also receives 
the superior. cava. During foetal life there is a commu- 
nication by a valve, called the foramen ovale, from the 
right to the left side of the heart, which becomes closed 
and obliterated after respiration is established. Through 
this valve much of the blood passes into the left side of 
the heart. From' the left ventricle, it escapes into the 
aorta, and from the right ventricle into the pulmonary ar- 
tery ; this latter, instead of conveying all its blood to the 
lupgs, disposes of about three- fourths of it through the 
ductus arteriosus to the descending aorta. A portion of 
the blood is sent from the aorta to the head and upper ex 
tremities ; but the remainder passes downwards to the iliac 
arteries, and what is not distributed to the lower extremi- 
ties, is returned to the placenta by the umbilical arteries 



ORIGIN OF HUMAN LIFE PREGNANCY. 



297 



of the cord, which pass from the internal iliac arteries, 
and join the vein of the cord at the umbilicus or navel. 
•The pulsation of the foetal heart varies from one hundred 
and thirty to one hundred and forty beats oer minute. 
(See the Foetal circulation.) 

Fig. 5.* 




As soon as the child is born and respiration established, 
the circulation is admitted through the lungs, and the 
foramen ovale becomes permanently closed. If by any 
irregularity it should remain open, the whole surface of 
the body of the child becomes of a leaden or blue color, 
which results from the non-oxygenization of the blood ; if 
this state continue, the child dies, sooner or later, asphyx- 
iated. Those vessels which were alone subservient to the 

*The child in utero at full term. Its position is represented in the ute- 
rus, the front walls of which, are laken away ; the intestines are pushed 
upwards and backwards, to give it room. * 



298 ORIGIN OF HUMAN LIFE PREGNANCY. 

f(jetal circulation, soon become obliterated, existing only 
as ligaments, and the last vestiges of the foetal peculiari- 
ties are at an end. 

When we compare the gravid uterus, or full period 
of pregnancy, with the unimpregnated organ, we can but 
be astonished at the change, in size, which has taken place 
during gestation. The virgin uterus is from two and a 
half to three inches long, about two broad, and one inch 
in thickness, with a cavity about the size of the kernel of 
an almond ; its superflees are about sixteen inches. But 
at the end of the ninth month of gestation it has attained 
a length of twelve or fourteen inches, a breadth of from 
nine to ten, and a thickness of from eight to ten inches ; 
its superfices is now estimated at 339 inches, having in- 
creased more than 519 times its original size ! 

As'we have already given the progressive development 
of the foetus, we have only to remark, that this augmenta- 
tion in volume takes place more gradually in the earlier 
months of pregnancy, than after the fifth month ; particu- 
larly during the last three months its growth is very rapid. 
The increase in size is not so much owing to the addition 
of muscular fibre, as to the enlargement of the uterine 
vessels ; indeed, the walls of the uterus maintain about 
the same degree of thickness throughout every stage of 
pregnancy, as existed before conception took place. The 
blood-vessels, however, are very much enlarged, carrying 
torrents of blood ; the lymphatics and nerves, also, are 
increased in size. 

The position of the child in utero, at full term, is seen 
in the above representation. During the whole period, 
the foetus is bent forwards upon itself so as to form a kind 
of circle ; but, until near the close of gestation, its posi- 
tion is not stationary. As the child floats nearly loose in 
the liquor amnii, the laws of gravity, principally, deter- 
mine its position. 

The natural duration of pregnancy in the human spe- 
cies is commonly said to be nine months ; but it may be 
more accurately estimated at forty weeks, or 280 days. 
Yet many instances are recorded, which are undoubted, 
of its continuing ten months, and even longer. Some au- 



ORIGIN OF HUMAN LIFE ABNORMAL PREGNANCY. 299 

thors mention pregnancies of twelve, thirteen, fourteen, 
fifteen, and even eighteen months, the correctness of which 
may be doubted. Dr. Merriman, of London, has given 
a table of the births of 114 mature children, from which 
we learn the following: three were born in the thirty- 
seventh week ; thirteen in the thirty-eighth week ; four- 
teen in the thirty-ninth week ; thirty-three in the fortieth 
week ; twenty-two in the forty-first week ; fifteen in the 
forty-second week ; ten in the forty-third week ; and four 
m the forty-fourth week ; of which latter, one was born 
at three-hundred and three days, one at three hundred and 
five days, and two at three hundred and six days. 

The instances are common in which children born at 
seven months complete, live ; instances are recorded 
wherein they have survived at six months complete, but 
such cases are comparatively rare ; those which are men- 
tioned as having lived at the fifth month, are somewhat 
ircredible. The law recognizes six months co?nplete, as 
being the least time in which they are capable of sur- 



ABNORMAL PREGNANCY. 

By abnormal pregnancy is indicated all those which 
deviate from the natural order, whether as to place, time, 
appearance, or form. 

By extra-utertne pregnancy, is understood those 
which occur out of the womb ; the embryo, generally im- 
perfect, has sometimes been found in the ovaria, some- 
times in the Fallopian tubes, and sometimes in the cavity 
of the abdomen. Another species may be added known 
as interstitial pi m egnancy, when the foetus is developed in 
the midst of the fleshy fibres of the uterus. This, how- 
ever, strictly speaking, does not belong to the class we are 
now considering. We adverted to these cases when 
speaking of the theories of conception in the last chapter : 
the remarks there made need not be repeated. Much that 
has been written upon this subject can only be regarded 
as fabulous. The phenomena attending them, and the 
length of time that they have been known to continue. 



300 ORIGIN OP HUMAN LIFE — ABNORMAL PREGNANCY. 

which has been sometimes many years, and their occur., 
rence in virgins, render it impossible to regard them oth- 
erwise than as utterly different from ordinary pregnancy. 
Instances are mentioned in which the foetus has been re- 
tained in this manner for upwards of fifty years. They 
are cf such rare occurrence that these strange deviations 
from the intentions of nature have been doubted altogether 
The tubal species seems to be the best substantiated, being 
more common than the others. 

The cause of extra-uterine pregnancy, is very obscure. 
All those who have attempted to assign one, have imputed 
its occurrence to some irregularity in the detachment of 
the ovum ; either that it arises from unnatural excitement 
in the female without sexual congress, or, that it is occa- 
sioned by fright during coitus. When the child has been 
found in the abdomen, it has by many been supposed to 
have escaped from the womb. In almost all such cases 
the foetus has been found very imperfectly developed. It 
is happily of rare occurrence, but when it takes place the 
termination is often unfavorable. 

By superfoetation, is meant the impregnation of a 
woman already pregnant. As it is well known that the 
mouth of the uterus is closed soon after conception has 
taken place, by the secretion of the decidual membrane, 
it.appears unreasonable that such an event should hap.pen ; 
and many distinguished physicians doubt its occurrence 
altogether. Still, it is well known that females in twin-de- 
liveries, have produced infants of different sizes, and va- 
rious colors, and within a few weeks, and even months of 
each other. We believe that these cases are mostly ex- 
plainable in the following manner : the expulsion of a 
twin may take place before its full term, while the other is 
carried till the ninth month ; or one of the germs may 
prove to be a blighted conception, and have the appear- 
ance, when born, of being a foetus of several months. 
When they have been of different colors, it is known that 
the mother received the embraces of a white and black 
man within a very short time of each other. Or it may 
be the result of a double uterus. 

Finally, then, it would appear that if superfoetation be 






ORIGIN OF LIFE ABNORMAL PEGNANCY. 391 

ever possible, the second embrace must take place almost 
contemporaneously with the first ; and even then it might, 
perhaps, be more properly regarded as a case of twkis 
simply, whether they belong to one or two fathers. 

Mole pregnancy results from the destruction of the 
vitality of the embryo during the first few weeks of its 
existence. If. its expulsion does not take place, it may be 
retained and continue to grow till it forms a fleshy mass 
known as mole or false conception. See chapter on Moles, 
Hydatids, etc., Book I., where this subject is fully ex- 
plained. 

Deformities, monstrosity and marks, called also lusus 
natural, are of various kinds. They may consist of defi- 
ciency, excess or misplacement of parts, or members of the 
body. For example, we frequently meet with persons 
who have an extra toe and finger, and more commonly 
those who have the naivus maierna, or mother's mark. 
The nose, the palate forming hair lip, one or more of 
the limbs, etc., have been wanting. In short, almost 
every part of the body, in different cases, has been found 
wanting, in excess, or misplaced. Some -of these mon- 
strosities are, of course, incompatible with life, others are 
so slight as to permit a continuance of life, while others 
aie capable of being remedied by operations. 

A variety of opinions are entertained in regard to the 
causes of these deviations from the original intention of 
nature . while a majority regard them as the product of 
the imagination of the mother, others trace them to a 
variety of injuries during gestation : as blows on the abdo- 
men, the pressure of corsets, etc. If we add to these, 
frights, unpleasant sights, severe mental agitation, and 
other similar impressions, we probably have what are 
often, at least, the true causes. All twin monsters are 
simply the rpsult of the growing together of the embryos, 
probably from some slight cause. 

That all these irregularities of nature are produced from 
comparatively slight causes, appears evident from the 
fact that monsters in chickens, may be produced at plea- 



302 ORIGIN OF LIFE — ABNORMAL PREGNANCY. 

sure, only by a slight increase of the heat of the eggs 
during incubation. 

By false pregnancy, is indicated a variety of affections 
that may simulate true pregnancy ; some of them are 
products of conception, while others are quite independ- 
ent thereof. We may mention among these, moles, am- 
enorrhea, dropsy, tympanites, polypi, cancer of the womb, 
ovarian dropsy, etc. 

As we have treated of these various affections in sepa- 
rate chapters in Book L, of this volume, and shown where- 
in their symptoms differ from those of true pregnancy, we 
have here only to recommend the reader to study them in 
connection with the signs of pregnancy, which follow in 
the next chapter. . 



Is IT POSSIBLE TO PROCREATE EITHER SEX AT PLEASURE ? 

The answer to this important question has been sought 
for, from the time of Hippocrates downwards. The. fa- 
ther of medicine taught that, as the strongest side belongs 
to the strongest being, in both animals and the human 
species, the right testicle and the right ovary produce 
male germs, while female germs come from the left. 
And thus has arisen the grave expedient of lying on the 
side where the germ of the sex desired is to be found, dur- 
ing a fruitful congress. We have only to remark that it 
has been demonstrated, that the basis of this hypothesis is 
entirely false. 

Without following out the different suppositions by 
which physiologists hoped one day to be able to ascertain 
the conditions which cause one sex to be born rather than 
the other, we should state that it has been demonstrated 
by experiment upon animals, that the stronger the male 
at the period of fecundation, the greater is the chance of 
obtaining males. Consequently, it is probable, as Vel- 
peau remarks, that the nature of the sex is determined by 
that one of the couple, whose prolific power, whether ab- 
solute or relative, is greatest at the moment of concep- 
tion. 

We have thus, by adverting to this point, included eve* 



ORIGIN OF LIFE SIGNS OF PREGNANCY. 303 

rything of any importance connected with this part of our 
subject, and shall proceed to consider the signs of preg- 
nancy, and afterwards its diseases. 



CHAPTER VI. 

THE SIGNS AND PHENOMENA Of PREGNANCY. 

Hippocrates remarked, that first, the female feels a dis- 
position to faintness, slight shivering, colic pains, with a 
rumbling sensation, first in the uterus, and then through- 
out the whole abdomen. This first condition, which is 
not constant, neither is it noticed by all females, is suc- 
ceeded by pregnancy, and its signs. The eyes lose their 
brilliancy and become languishing ; the eyelids become 
dark, and are surrounded by a livid or leaden circle ; the 
nose becomes sharper, the mouth wider, the chin more 
prominent; thence becomes pale and covered with red- 
dish spots of various sizes and numbers, — sometimes of a 
milk color, — finally it may be said to become masked. 
The general state of a woman in this condition, is ple- 
thoric, as is indicated by the pulse, which is quicker and 
fuller than ordinary. The blood, upon being drawn, is 
found to have the buffy coat, indicating an increase of 
fibrine. Sympathies are excited in distant organs, which 
are often distressing, giving rise to various caprices of dis- 
position and taste. We should remark, before proceeding 
further, that the diagnosis of early pregnancy is often no 
easy task, but one which requires great care and discrimi- 
nation. The following are the principal signs to be re- 
lied on : 

1. Cessation of menstruation is one of the most im- 
portant signs, if the female have previously been regular, 
and there is no evidence that this function is suspended by 
cold, serious disease in other parts of the body, depressing 
emotions and passions, or a low state of the general health ; 
when any of these affections supervene, they give rise to 
dizziness of the head, etc, (see Suppression of the Men- 
ses, Book 1.,) by which they may be distinguished from 



304 ORIGIN OF LIFE — SIGNS OF PREGNANCY. 

pregnancy. In extremely rare cases menstruation has 
been known to continue for a month or so after impregna- 
tion, the discharge being produced by the lower part of 
the uterine "cavity, which is not yet occupied by the decid- 
ual membrane ; in still more rare cases, the menses have 
been known to flow throughout the whole period of utero- 
gestation ; — but these are exceptions. If, at the second 
period, the menses are absent, it may be deemed conclu- 
sive, or very nearly so, that conception has taken place. 

2. Morning sickness, and sometimes vomiting, is pre- 
sent in most cases, but not all. 

3. Enlargement of the breasts, areola around the 
nipples, and secretion of milk, are good symptoms, but are 
sometimes, as has been seen, produced by uterine disease. 

4. Salivation is often produced by the irritation of 
pregnancy, when there is a frequent disposition to spit. 

5. Enlargement of the abdomen, which might be 
supposed one of the best signs, taken by itself, is one of 
the worst, and is not to be relied on. This arises from the 
fact that it may be produced by numerous other causes ; 
and very unjust and painful suspicions have been attached 
to unmarried females from this doubtful symptom. 

6. Enlargement of the uterus is a symptom of more 
value, when estimated by a prudent physician, than the 
preceding ; early in pregnancy its neck becomes lower in 
the vagina, and as pregnancy advances, the neck shortens, 
until at full term, nothing is left of it but a narrow ring, 

7. Quickening, or movement of the child, is the only 
infallible sign of pregnancy — when we are assured that 
it is not the result of the woman's fancy. This may oc- 
cur at any time after the third month, though the fourth 
is the most common. It may be felt by bareing the abdo- 
men, and applying the hand over the tumor, previously 
dipped in very cold water. 

8. Beating of the fcetal heart, is another infallible 
sign. By the use of the stethescope, or even by applying 
the ear directly to the abdomen, it may be heard beating 
at the rate of one hundred and thirty or forty per minute. 
These signs, of course, do not exist till after quickening, 
and not then if the child be dead. If it be a twin preg. 
nancy, two fcetal hearts may be heard. 



ORIGIN OF LIFE SIGNS OF PREGNANCY. 305 

9. The urine is more abundant, more pale and limpid 
than ordinary. 

10. A capricious appetite generally exists ; sometimes 
there is an entire loss of it, at others it becomes ravenous, 
then again the female has a desire for the most indigesti- 
ble articles, such as ashes, clay, lime, charcoal, unclean 
insects, etc. 

The moral condition of the. pregnant female, is also sub- 
ject to many changes. Some who were before naturally 
gay, and amiable, now become melancholy, cross, unsocia- 
ble, and vice versa, " In a good many women," remarks 
Velpeau, " the passions, although previously moderate, ac- 
quire an extraordinary violence, cannot be subdued, and 
cause the commission of the most attrocious crimes ; in 
others, there are merely some singular desires, such as to 
eat a particular kind of fruit, meat, or game, or some par- 
ticular dish, no matter at what price ; an irresistible ten- 
dency to steal objects of small value, or for which they 
have no use, and corruption of their manners or charac- 
ter. There are some whose wit is never more lively, 
more penetrating, more agreeable ; while others fall into 
a sort of stupidity and apathy, quite unnatural in them. 
In general, the activity of the intellectual faculties is 
augmented, whether in the whole, or only in part ; in one 
case the memory, or a taste for the arts and sciences, is 
modified ; in others the judgment becomes exquisite, or 
the imagination is exalted to such a degree, that some 
women have, during their pregnancy, attained to a sur- 
prising degree of perfection in those works of genius, 
those arts or sciences, which they had previously cultivat- 
ed with indifference, and without success ; some lose their 
senses and become insane, always at the same period of 
their pregnancy ; others are seen in whom mania never 
disappears, and who never become composed except dur- 
ing this function." 

Notwithstanding the multitude of signs of pregnancy 
already noticed, in some cases the most skilful, in estimat- 
ing them, are deceived. This arises from the fact that 
certain affections and conditions of the uterus, intestines 
and abdomen, may take on nearly all these symptoms. 
Numerous cases are on record in which false decisions in 



306 MANAGEMENT OF PREGNANT WOMEN. 

pronouncing young females pregnant, have led to the 
most melancholy and lamentable results ; the errors have 
only been discovered when it was too late to remedy the 
evils produced. Whole families have been broken up, 
characters destroyed, and women have been driven to sui- 
cide to escape the taunts of their associates, or had their 
whole lives embittered, when their perfect innocence has 
appeared. These evils have, in part, originated from the 
fact, that young women, illegitimately pregnant, generally 
deny the fact, maintaining that they are slandered, thus 
producing error in the opposite direction: this has led 
many skilful physicians to disregard entirely the asser- 
tions of the subject, and rely altogether upon appearances, 
which may be deceptive. 

As during pregnancy, there exists a much greater de- 
gree of vitality in the uterus, than previously, there occur 
a variety of modifications, both anatomical and physiologi- 
cal. Many diseases supervene, are suspended, or disap- 
pear. It has been noticed that an advanced stage of pul- 
monary consumption, and a number of other different dis- 
eases, such as obscure chronic inflammations, and even 
serious organic lesions, seem to retrograde during preg- 
nancy, and often give place to a flourishing state of health. 
After parturition, some of these do not return, and 'are 
found to be permanently cured; while, again, many of 
them thenceforth progress towards a fatal termination with 
increased and frightful rapidity. 



CHAPTER VII. 

HYGIENE* AND MANAGEMENT OF PREGNANT WOMEN. 

While a pure atmosphere is of the highest importance 
to health at all periods of existence, it is during the preg- 
nant state, especially, that it becomes indispensable. Hip- 
pocrates, and many others, have remarked the bad effects 
of a damp or too dry an atmosphere, upon pregnant wo- 
men, and assert that it predisposes to abortions and to 

* Being a continuation of M. Colombat's remarks upon this subject. 



MANAGEMENT OF PRDGNANT WOMEN. 307 

premature labors. They ought, therefore, as far as possi. 
ble, to breathe an atmosphere which is pure and exempt 
from all extremes of cold or heat, dryness or humidity. 

Their clothing should be loose, and so arranged as to 
avoid all pressure upon the breasts, chest, abdomen, and 
stomach. Pressure upon these organs may interfere with 
the growth of the mammse and the development of the 
nipples ; it may augment the embarrassment of respira- 
tion, prevent the enlargement of the uterus and its ascent 
in the abdomen ; and, lastly, become a cause of abortion, 
or of displacement of the gestative organ. Pregnant wo- 
men should especially avoid the use of corsets with busks 
or whalebones, which are very hurtful, while the pressure 
they exert from above downwards acts upon the uterus, 
forces it to develop itself in a dependent situation, and be- 
comes a powerful cause of prolapsus of the uterus, and 
according to some authors, a cause of deformity of the 
foetus, even. They ought to wear, therefore, elastic and 
very large corsets only ; for which should be substituted, 
after the fifth month, an equally elastic binder, which, 
embracing the abdomen in every direction, maintains the 
uterus in a normal position, and, as far as possible, pre- 
vents the wrinkles and cracks which are generally the 
result of pregnancy. During winter, pregnant women 
ought to take care to wear flannel drawers, in order to 
escape the action of the cold upon the thighs and external 
organs, which are more exposed to it because of the 
prominence of the abdomen, which shortens the under 
clothes, and pushes them forwards. They ought to 
endeavor, likewise, to protect the mammae, the shoulders, 
and the superior extremeties, from cold. Inattention to 
this precept has sometimes occasioned very extensive in- 
flammation of the breasts, followed by abscesses, which 
have not generally been cured till after delivery. Circular 
compression of the inferior extremities is no less danger- 
ous, especially towards the latter months of gestation, for, 
by retarding the flow of the fluids, they produce cedema- 
tous engorgements and varicose dilatations of the inferior 
extremities. 

The use of warm baths, which Wkire always proscribed 
by the ancients, in pregnant women, is nevertheless very 



303 MANAGEMENT OF PREGNANT WOMEN. 

useful. As they promote the cutaneous perspiration, relax 
the tissues, and cleanse the skin, they are suitable for 
primiparous women, and especially for those of advanced 
age, whose soft parts are hard and resisting, and whose 
uterine and abdominal parietes are distended with difficul- 
ty ; they are prescribed, also, for the purpose of relaxing 
the symphyses of the pelvis, of softening the external 
parts of generation, of preventing lacerations, and to fa- 
cilitate labor. The use of baths is suitable also for ner- 
vous and irritable women, who are very subject to colics 
and convulsions ; they are injurious in those who have 
much embonpoint, in those o£ lymphatic temperament, 
and who are subject to edema and hemorrhages. Persons 
of the latter description, should make use of them only 
for purposes of cleanliness, therefore, and should remain 
in them as short a time as possible. In some cases, cold 
baths may be proper. Foot-baths ought to be allowed, 
only for the purposes of cleanliness. 

Bleeding ought to be avoided, unless some accident hap- 
pen, or unless called for by some particular indication. 
It sometimes becomes necessary, at all periods of preg- 
nancy, in plethoric women, in whom the pulse is strong, 
full, and accelerated, and who suffer from insomnia, from 
excessive agitation, from headache, or from nasal, pulmo- 
nary, or uterine hemorrhages. Bleeding at the arm in 
these cases, is generally preferable to any other mode of 
abstracting blood. 

The derangements of the digestive functions, and the 
state of sanguine plethora, which are the general results 
of pregnancy, sufficiently indicate that pregnant women 
ought, especially during the early months, to make use 
only of light food, containing but little nutritious matter, 
of easy digestion, and selected chiefly from amongst the 
vegetables. Nevertheless, towards the middle of gesta- 
tion, the period at which the appetite re-appears, and the 
digestive functions are generally re-established, it becomes 
proper to relax the severity of the regimen, and allow of 
more food at each repast ; with the precaution, however, 
of renewing the latter often enough to supply sufficient 
nourishment, without overloading the stomach. The 
reprehensible custom of making pregnant women eat for 



MANAGEMENT OF PREGNANT WOMEN. 309 

two, as it is vulgarly expressed, is the more pernicious, 
because it occasions a super-excitation of the digestive 
organs, which is generally followed by more or less obsti- 
nate vomiting, colic or diarrhoea. We must remark, 
however, that the tastes and desires of the patient should 
be respected, provided they do not concern articles evi- 
dently injurious. Though it is wrong to yield to all their 
caprices of appetite, it is also wrong to resist desires which 
often persist in spite of them, and which are sometimes 
the indications of nature itself. It is proper to remark, 
moreover, that the excessive use of warm drinks may be 
hurtful, by debilitating and relaxing the stomach ; and 
that the abuse of fermented drinks, of liquors, of tea and 
coffee, and of irritating condiments, is equally pernicious, 
by increasing the already too great excitation of pregnant 
females, from which may result convulsions, uterine 
hemorrhages and abortions. The use of ice drinks, which 
is often one of the best means of allaying gastralgia and 
vomiting, may also become a cause of abortion. 

In some women, we find disorders of the intestinal ex- 
cretions, and of the urinary secretion. Emollient enemata 
will be useful to calm, not only intestinal and vesical ir- 
ritations, but also to facilitate digestion, to' prevent and 
overcome vertigo and cerebral congestions, and even to 
aid in the primipara, the dilatation of the genital parts, at 
the moment of delivery. Nevertheless, their habitual use 
should be restricted to the well-ascertained cases that re- 
quire them ; for they may lead to constipation and intes- 
tinal torpor, and an abnormal relaxation of the genital or- 
gans. One ought especially to be very circumspect as to 
the use of purgative injections, w T hich, in consequence of 
the relations existing between the rectum and womb, may 
bring on contractions of that organ, and thus give rise to 
miscarriage. As a general rule, purgatives ought to be 
rejected upon the same considerations ; and the conduct 
of those who prescribe what are called 'precautionary pur- 
gatives, cannot be too much condemned. The use of 
emetics ought also to be proscribed ; and notwithstanding 
they are often taken, without effect, by women who de- 
sire to make a criminal use of them, still they should 
never be resorted to except in cases of absolute necessity. 
14* 



BIO MANAGEMENT OF PREGNANT WOMEN. 

Exercise, which ought never to be carried to the extent 
of fatigue, is very useful for pregnant women ; it main- 
tains a regular action of all the functions, prevents the at- 
tack of many diseases, and is often a means of cure. 
The most suitable mode of exercising for such persons, is 
walking, both morning and evening, during the fine 
weather, and at noon during the winter. The length of 
the walks should be calculated agreeably to the state of 
the strength and habits of the woman ; yet there are 
women who cannot go out their full time except on the 
condition of keeping perfectly still, and in a horizontal pos- 
ture. Riding on horseback, or in a carriage, and dancing, 
exposes her to shocks that are the frequent causes of 
hemorrhages and abortion. Moreover, women in a state 
of pregnancy, ought to enjoy protracted sleep, which, in 
that state, they require more than at any other period of 
their lives. We ought, therefore, to treat the state of in- 
somnia and agitation to which they are liable, especially 
in the last months of pregnancy, by baths, exercise, and 
blood-letting, and by some gentle narcotic, such as distill- 
ed lettuce-water, and orange-flower water, to which may 
be added some drops of sulphuric ether. The prepara- 
tions of opium do not always succeed so well. 

The exalted state of the sensibility in pregnant women, 
rendering their sensations more acute, and their emotions 
more energetic, they ought to shun the occasions of vio- 
lent impressions upon the physical and upon the moral 
constitution ; and all objects capable of affecting the ima- 
gination, should be cautiously kept out of their way ; such 
as tragical spectacles, the sight of mutilated people, of the 
lame, and of all persons affected with loathsome diseases. 
As they are, in general, persuaded, that the sight of such 
an object may give rise to a similar deformity in the child 
in utero, they are violently agitated whenever they meet 
with it. Besides, the records of disease are full of cases 
of serious disorders, as convulsions, hemorrhages and 
abortions, brought on by the sight of some repulsive ob- 
ject, by fright, by a paroxysm of anger, a fit of joy, of 
hate, of jealousy, or other acute emotion of the soul. 
From among the numerous histories of this sort, we shall 
quote only one, from (he writings of Sue. It is the case 



MANAGEMENT OF PREGNANT WOMEN. 311 

of a woman who was so much affected by the prediction 
of a gipsy, who foretold that she would die, that she made 
her will, and died in the eighth month. 

It would seem ridiculous, to believe in the injurious ef- 
fects of longings and desires, and the prejudices which 
pretend that the woman's imagination may exercise a pow- 
erful influence upon her child, and that when she longs 
for any thing, or is powerfully affected by any object, 
there is established a deformity resembling the object of 
her fright, upon that part of the infant's body that corres- 
ponds to the part of her own surface which she happens 
first to touch with her finger, after experiencing the sen- 
sation. However, as these various causes may produce 
violent agitation in credulous females, and exert an injuri- 
ous influence upon the foetus, it is requisite to pay great 
attention to the state of her mind, so that she may be 
treated with gentleness and respect, and especially with 
indulgence as to her caprices and oddities, which are for 
the most part involuntary. As abortion is often the con- 
sequence of the voluptuous and tumultuous ecstacies of 
the venereal indulgence during pregnancy, the conjugal 
embrace ought to be interdicted during the early months, 
particularly to newly-married women, and to those who 
have already been subject to abortion. In case, however, 
of excessive desire in both parties, there might be more 
inconvenience in resisting, than danger in gratifying it, 
with moderation. As, during the last six months of ges- 
tation, the danger is much less than in the first three 
months; the indulgence of the habit maybe enjoyed with 
less restraint* 



section n. 
DISEASES OF PREGNANCY, 



Soon after conception has taken piace, the uterus as* 
sumes new strength, and radiates to other parts of the 
economy, the most extraordinary sympathies, and the most 
powerful re-actions. Some of these have been mentioned 
as the signs of pregnancy, most of which require no other 
attention than a regulation of the habits of the individual ; 
but others that are sympathetic or physiological, which 
often take on a pathological appearance, and are known 
as the diseases of pregnancy, may be divided, for con- 
venience, into classes : the nervous, the plethoric, and the 
mechanical — which take place at different periods of ute- 
ro-gestation. We shall somewhat modify these divi- 
sions — I. Treating of abortion or miscarriage ; 2. Disor- 
ders of the chylopoietic viscera or the digestive functions ; 
3. Disorders of the circulating system ; 4. Disorders of 
the respiratory system ; 5. Disorders of the nervous sys- 
tem and senses; 6. Disorders arising from mechanical 
pressure or distention ; 7. Diseases of the genital organs 
during pregnancy. We shall, then, proceed to treat of 
them, according to these divisions, in as many chapters. 



CHAPTER I. 

ABORTION OR MISCARRIAGE CAUSES SYMPTOMS AND 

TREATMENT. 

By abortion is understood the expulsion of the foetus 
from the uterus before it has attained a sufficient degree 
of development to enable it to exist independently of the 
mother ; if it occur before full term, and the child have 



ABORTION OR MISCARRIAGE CAUSES. 313 

acquired an organization sufficiently perfect to enable it 
to live, it is called a 'premature labor. It should always 
be regarded an " untoward event," as it generally exerts 
an unfavorable influence upon the health of the female. 

Abortion has been observed to occur most often in the 
early months of pregnancy ; consequently, as it becomes 
advanced, the chances of this accident taking place are 
lessened. According to the records of Drs. Collins, 
Beatty, Deubel, and Madam Lachapelle, out of 41,699 de- 
liveries, 530 were premature births or abortions ; making 
1 in 78 1-2. 

Causes. — These we shall divide into the predisposing 
and exciting. The efficient cause, of course, is constitut- 
ed by the contractions of the womb, assisted by the mus- 
cular power of the mother. 

The predisposing causes may exist in the woman or in 
the ovum ; most often in the former. According to Vel- 
peau, women who are plethoric, who menstruate abun- 
dantly and regularly, who are irritable, excessively sensi- 
tive, nervous, hysterical, lymphatic, of a fair complexion, 
weakly, sickly, who have large eyes and a bluish scleroti- 
ca ; persons affected with syphilis, scurvy, rickets ; 
those who have a badly formed pelvis, some Organic lesion, 
or any chronic disease; those who are asthmatic, dropsi- 
cal, affected with cancer ; those who are badly nourished, 
and those who compress themselves by lacing, or wear their 
clothes too tight, miscarry more frequently than others. 
Marshy and unhealthy countries ; certain atmospheric 
constitutions, formerly noticed by Hippocrates, which ren- 
der abortions really epidemic at some seasons ; watch- 
ings and fatiguing occupations are also classed among the 
predisposing causes of miscarriages. On the part of the 
reproductive organs, all the chronic affections to which 
they are subject, might be mentioned ; as adhesions, dis- 
placements, cancer, polypus, profuse uterine leucorrhea 
or dropsy, etc. 

Many of the diseases to which the child is liable after 
birth, may manifest themselves before — thus giving a dis- 
position to abortion ; ulceration and disorganization of the 
head, lungs, liver, peritoneum, and in fine, of every part 
of the body has been observed as early as the third month. 



314 ABORTION OR MISCARRIAGE CAUSES. 

Circumvolutions of the cord around the child's neck, its 
shortness, excessive length, or its containing knots, may 
also cause the death of the child, when it will be, sooner 
or later, expelled. 

Exciting causes. The predisposing causes that we 
have mentioned, are, alone, very often sufficient to bring 
on the expulsion of the ovum ; when this occurs the abor- 
tion is said to be spontaneous. Notwithstanding, it is al- 
most always attributed, and often erroniously, to some ac- 
cident or particular circumstance which is known as the 
exciting, and passes as the principal cause ; as great ex- 
ertions, yawning, coughing, sneezing, vomiting, the act of 
voiding the faeces and urine ; the impressions of joy, dis- 
appointment, sorrow, anger ; strong odors of any kind ; 
coitus, violent dancing and other movements, riding in a 
carriage or on horseback, leaping ; and in fine, all vio- 
lent commotions of the body, and blows or falls upon the 
abdomen. To these may be added all acute diseases, as 
fevers, inflammations, especially of the womb ; dysentery, 
colic, constipation, convulsions, etc. 

Now, although many of these causes seem frequently 
to give rise to abortion, it should be understood by the 
reader, that they would rarely produce it without the an- 
tecedent existence of some one of the predisposing causes 
above enumerated ; and that they most commonly are 
merely coincidences. The same may be said of emetics, 
drastic purgatives, and emmenagogues, taken for criminal 
purposes ; blood-letting, from the foot or otherwise ; hip 
and foot baths. Mechanical means which have been re- 
commended in cases of deformity of the pelvis, acupunc- 
ture, and certain manoeuvres acting directly upon the 
ovum, but which, unfortunately, are resorted to by infa- 
mous people, it will soon be seen, are often no more suc- 
cessful than the foregoing, and attended with the greatest 
danger. It has been thought that many of these causes 
act by detaching the placenta ; but if it be considered that 
the ovum is perfectly filled with the foetus and liquor 
amnii, and that the uterus is filled exactly by the ovum, 
it will be evident, as Dr. Velpeau remarks, that motions 
impressed on the womb by external shocks, are as incapa- 
ble of separating the placenta from the womb, as thev 



ABORTION OR MISCARRIAGE CAUSES. 315 

would be to separate two bladders, one contained within 
the other, and the inner one full of fluid ; the most active 
and imprudent women, those who give themselves up to the 
most violent exercises, do not, on that account, fail, most 
generally, to go their full term ; while many others are 
found to abort in spite of the most minute precautions, and 
the most persevering attention. 

Dr, Mauriceau relates the case of a woman, seven 
months gone with child, who, in order to escape from her 
chamber, which was on fire, got out of a third story win- 
dow, when she fell on to the stones and fractured her 
arm ; but her pregnancy was not disturbed. Madam 
Lachapelle mentions that a female who was pregnant, and 
a fleeted with deformed pelvis, threw herself from the top 
of a stair, with the view to bring on abortion, and thereby 
avoid the Cresarian section : she died a few days after- 
wards from her injuries, but there was no abortion. Mari- 
ceau also speaks of a woman who was bled eighty-six 
times in one pregnancy, and who, notwithstanding, at the 
end of it, was delivered of a fine large child. Delmotte 
saw powerful evacuants produce gastritis, peritonitis, and 
even death, without being followed by abortion ; Velpeau 
had the care of a young female who, with the design of 
concealing her dishonor, had produced a violent abdomi- 
nal inflammation by taking medicines to procure abortion : 
she died on the eighth day without any symptoms of mis- 
carriage. We should add, however, that where some pet 
culiar predisposition exists, these powerful means may 
produce that event, while in others they may give rise to 
monstrosity or malformation of the child. 

There is a predisposition to abortion common to all 
women ; that is, at the menstrual periods, — an epoch when 
a fluxion towards the womb occurs, which disposes the de- 
tachment of the ovum. Finally, those women who are so 
unfortunate as to acquire the habit of aborting, are rarely 
afterwards aWe to carry the foetus beyond the period at 
wlfich they are accustomed to miscarry; the oftener this 
is repeated, the more difficult it is for them to carry it to 
full term. Such individuals are doubly unfortunate ; it 
nQt only prevents their becoming the mothers of living 



316 ABORTION OR MISCARRIAGE SYMPTOMS. 

children, but also gives rise to a state of bodily debility 
from which they severely suffer. 

A great number of medicines are supposed capable of 
producing miscarriage ; but there is no certainty in their 
action, however powerful they may be. She who resorts 
to them, is guilty of tampering with her own life, in addi- 
tion to the crime actually intended. The remarks of Dr. 
Velpeau are particularly apposite in illustrating our views 
upon other means that are sometimes resorted to: "the 
mechanical causes, or certain manoeuvres recommended by 
some authors, in cases of deformity of the pelvis, and 
which, in the midst of our refined society, are also em- 
ployed by degraded wretches, not less criminal than the 
unnatural women, who are not ashamed to submit to their 
disgusting ministrations, must be arranged among the 
same class, with emmenagogues and drastic purgatives. 
Those who make use of them most frequently fail of at- 
taining their object, and succeed only in seriously injuring 
the womb. I once prescribed for a female, in whom such 
attempts had brought on a flooding which conducted her 
to the verge of the grave ; she suffered horribly from pain 
in the interior of the pelvis for two months, notwithstand- 
ing which abortion did not take place, and she is now a 
prey to a large ulcer of the neck of the womb. I opened 
the body of an unhappy creature who suffered from the 
like attempts, which did not succeed any better than the 
one above mentioned. M. Girard, of Lyons, mentions a 
similar instance. Very recently a young woman, who be- 
came pregnant against her wishes, succeeded by such ma- 
noeuvres only in producing an organic lesion of the ute- 
rus, which, after frightful sufferings, led her to the com- 
mission of suicide. 55 The same, also, applies to bleeding 
and all other unnatural attempts to bring about a prema- 
ture expulsion of the foetus. 

Symptoms. — These vary according to the stage of the 
pregnancy, and the nature of the causes which produced 
it. During the first two months of gestation, and when 
the result of some disease, the ovum, then of small size, is 
often expelled with little or no pain or hemorrhage ; this 
kind of miscarriage does not much differ from a slight 
attack of hemorrhage, or a difficult menstruation. When 



ABORTION OR MISCARRIAGE TREATMENT. 317 

pregnancy is farther advanced, however, the expulsion of 
the foetus may produce the phenomena of an ordinary 
labor ; but it is generally preceded by weakness, chills, 
languor, paleness of the face, palpitation, fetid breath, 
swelling and dark color of the eyelids, loss of appetite, 
nausea, thirst and pains in the loins. There may be also, 
elevation of the pulse, the breasts become faccid and se- 
crete a serous liquid instead of milk ; there is a discharge 
from the vulva, at first of a thin humour, then of blood ; 
absence of the movements of the child ; and lastly, falling 
of the abdomen, uterine pains which gradually become 
stronger and more frequent, till the mouth of the uterus is 
dilated, when the ovum is expelled, which most often puts 
an end to the hemorrhage. 

When abortion is the result of some powerful exciting 
cause, the action of such cause is immediately followed 
by an abundant, and frequently dangerous flow of blood, 
that does not cease till the discharge of the foetus and its 
appendages takes place, which is accomplished by severe 
pains ; these symptoms resemble those of labor the more 
closely in proportion as the age of the foetus is more ad- 
vanced ; the same is true in regard to the lochial discharge 
and milk fever. 

When the child has ceased to live it is generally soon 
expelled from the uterus ; it may, however, remain for 
several weeks or months, and even years — if the mem- 
branes remain unbroken, and no air have penetrated the 
uterus — passing sometimes into the state of adipocire ; or, 
it may degenerate into zjleshy mole. (See that Chapter 
in Book I.) 

Abortion is much more dangerous than a natural labor ; 
the least dangerous, is that which is produced by disease 
of the ovum, and the most so, is that which is forced, 
without the existence of any predisposing cause. The 
danger of tne female is also less in proportion as the preg- 
nancy is more recent, and the neck of the womb is more 
yielding. It often disposes the womb to chronic inflam- 
mation, ulcers, and other organic lesions. 

Treatment. — This presents two indications : first, to 
prevent it by every possible means; and second, if this 
15 



318 ABORTION OR MISCARRIAGE TREATMENT. 

be impossible, to hasten its termination and attend to the 
state of the mother. 

If the female be irritable and nervous, she should be 
protected from moral and physical commotions ; she may 
avail herself of travelling, and if weakly she should take 
strengthening food, repose, and moderate exercise only ; 
tonic medicines may be often advantageously used. She 
should avoid violent exercise, indigestible food, tight dress, 
emotions of the mind, and unpleasant weather. If there 
be a disease of the uterus or other organs, it should be 
carefully attended to. When signs of plethora and con- 
gestion exist, blood taken from the arm will be useful, 
which may be repeated near the time of the menstrual 
period, according to circumstances. But this latter reme- 
dy should not be indiscriminately resorted to in all cases, 
as is practised by some physicians. According to Dr. 
Physic of Philadelphia, if the patient have had repeated 
miscarrage she may employ with the greatest success, an 
anodyne enemata, consisting of a wine glassful of boiled 
starch, mixed with forty drops of laudanum, to be taken 
at bed time, and repeated every night till quickening takes 
place. (Meigs.) 

When hemorrhage occurs, the patient should immedi- 
ately assume the horizontal posture and maintain absolute 
rest upon a hard and fresh matress. Cold, astringent and 
ascidulated drinks should be exhibited, external revul- 
sives, the application of ice ; antispasmodics and anodyne 
preparations ought to be employed, if there exist symp- 
toms of nervous agitation or convulsions. . Should there 
be much congestion, bleeding from the arm may be resort- 
ed to, but with great caution. Bathing should be avoided 
so long as there is hope of opposing the abortion. When 
the hemorrhage is great, resource should be had to the 
tampon or plugging the vagina ; this may arrest the 
bleeding and the abortion too — or by the accumulation of 
blood which it causes in the uterus, it may determine the 
contractions of that organ and thus assist in the expulsion 
of the ovum. The ergot should only be used as a last 
resort as it generally hastens the expulsion of the foetus. 

•When all these means fail and abortion is known to be 
inevitable by the dilating of the mouth of the uterus, the 



NAUSEA AND VOMITING. 319 

delivery of the woman should no longer be retarded. 
Composing, anodyne drinks should be administered, and 
belladonna ointment to the neck of the uterus, or emolli- 
ent anodyne injections into the vagina will be useful. 
Should the ovum be detained too long in the neck, the 
finger may be introduced to assist its escape ; the uterine 
contractions may be excited by frictions to the abdomen, 
etc. The subsequent treatment, delivery of the placenta, 
and care of the female, is the same as that of an ordinary 
labor. 



CHAPTER II. 

DISORDERS OF THE CHYLOPOIETIC VISCERA OR THE DIGESTIVE 
FUNCTIONS CAUSES SYMPTOMS AND TREATMENT. 



NAUSEA AND VOMITING. 

Nausea and vomiting so frequently accompany preg- 
nancy, that their existence is generally the first sign of 
the occurrence of that condition. The former, although 
but .the first stage of the latter, often exists alone and is 
more distressing than vomiting itself. They are caused 
by the sympathetic action of the impregnated uterus upon 
the stomach. They generally come on soon after con- 
ception, and cease after the third or fourth month. Some- 
times, however, they continue throughout the whole preg- 
nancy, while again they cease at the usual time, but 
re-appear in the latter months. In some patients they 
never occur. 

The vomiting most commonly appears in the morning ; 
it may take place, also, in the course of the day, and par- 
ticularly just after meals. Some are able to retain little 
or no food, while others are relieved by taking it. It 
sometimes causes much emaciation and debility, and if the 
vomiting be frequent and violent, it may excite abortion. 
It is always important to carefully distinguish whether it is 
produced by pregnancy or gastric derangement. Though 



320 SALIVATION OR PTYALISM. 

sometimes the vomiting is exceedingly distressing, the 
prognosis is not often unfavorable. 

Treatment. — The woman should compose her diet of 
the lighter articles of food, and those that are found by her 
to be most easily digested. When there is a desire for 
those which are unsuitable in appearance, it may be bet- 
ter for them to be taken than no food at all. Some wo- 
men find relief from a little Madeira wine, brandy, or 
some other liquor, either after meals or before ; others, 
from mineral waters, bitter tonics, as columba root, a few 
drops of laudanum or ether, mint-water or syrup of poppy 
heads, extract of cinchona, and quinine. Counter irrita- 
tion has been found useful, either by cups or mustard 
over the stomach, or to the spine. The application of an 
opium plaster, or a cloth wet with laudanum, to the pit of 
the stomach, will often give relief. It is frequently ne- 
cessary, also, to exhibit mild purgatives, such as rhubarb, 
castor oil, a Seidlitz powder with syrup of senna, or man- 
na, and emetics even. The amployment of some of these 
with a spare diet, and the use of acidulated and gummy 
drinks, lemonade, baths, and emollient enemata, accord- 
ing to circumstances, will rarely fail of benefitting the 
patient. Finally, we should remark, that when there is 
much plethora present, bleeding from the arm, and after- 
wards the employment of antispasmodics and opium, will 
be an advantage. 

SALIVATION OR PTYALISM. 

This is characterized by an excessive secretion from 
the salivary glands ; it generally appears soon after con- 
ception, and ceases about the fourth month ; but in some 
cases lasts throughout gestation, or does not appear till a 
short time before labor. It is far more inconvenient than 
dangerous, and seems to depend upon the increased vitali- 
ty of the uterus. When it is slight, nothing need be done 
but to regulate the habits of the patient ; when it is ex- 
cessive, the bowels should be kept free by laxatives, ene- 
mata, and a suitable diet ; counter irritation by mustard 
or leeches may be resorted to, and slightly astringent gar- 
gles, as well as draughts of balm, mint and canella water. 






ODONTALGIA AND CAPRICIOUS ArPETITE. 321 

ODONTALGIA OR TOOTHACHE. 

This affection is generally a dental neuralgia which is 
more common during the earlier months of pregnancy ; it 
commences with more or less violent pains along the low- 
er jaw, or in individual teeth when any are diseased. Its 
effects upon the female are often very distressing ; — she 
loses her sleep and appetite, digestion becomes impaired, 
and if not relieved, abortion may result. 

In the treatment, sub-carbonate of iron, with rhubarb, 
has been recommended, with anodyne lotions and poultices. 
Relief is often obtained from the application of a blister 
behind the ear on the affected side, and leeches or scarifi- 
cation to the gums ; when the pain is intermittent, quinine 
with opium should be tried. In addition to these, when 
there is any inflammation, mild purging with saline ca- 
thartics, low diet, diaphoretic drinks, warmth and vapors 
to the head and mouth, should be used. When there is a 
carious tooth, it must be at once extracted, unless the pa- 
tient be so irritable as to make us fear abortion ; under 
such circumstances relief may often be obtained from the 
essential oils, creosote and opium. 

CAPRICIOUS AND FASTIDIOUS APPETITE. 

During the earlier months of pregnancy, the appetite 
diminishes, or is altogether lost ; but in the third or fourth 
month, it generally returns, and sometimes becomes vora- 
cious. But the most remarkable peculiarity met with, is 
when there is a disgust in the female for the articles of 
diet of which she was previously fond, and a desire for 
the most unreasonable substances : such as chalk, plaster, 
charcoal, flies, spiders, etc. The old writers abound in 
strange stories of the longings of pregnant women : Cas- 
tro relates that a female who took a fancy to a bite of a 
baker's shoulder, could not be satisfied till his consent was 
purchased. Langers mentions a woman who satisfied her 
depraved appetite by killing her husband, making a meal 
©f a part of him, and salting the rest. Others are men- 
tioned as having devoured pepper, brown paper, and bro- 
ken stones. These caprices are more common in the 

O 



322 CAPRICIOUS APPETITE — HEARTBURN. 

early months of pregnancy, and although many of such 
accounts are fabulous, it is well known that sometimes 
their wonderful tastes are carried to an excess amounting 
to monomania. 

In the treatment, as it is often useless to try to divert 
them from their caprices, there is no reason for denying 
them any thing, or for refusing to yield to a well-marked 
appetite, unless, indeed, the substances longed for are evi- 
dently hurtful. It is readily conceivable, that a disap- 
pointed wish, and an ungratified longing, carried to a 
certain extent, may produce dangerous consequences to 
the mother, and thus interfere with the formation and de- 
velopment of the embryo. (Colombat.) This condition is 
generally accompanied with gastric derangement for which 
purgatives and often emetics are requisite ; antispasmo- 
dics, opium; ether, etc. ; and if there be plethora, bleed- 
ing ; and finally, bitter infusions with a little wine. Ex- 
ercise should be taken, and excessive eating and drinking 
must be avoided. 

HEARTBURN OR CARDIALGIA. 

This affection may occur at a very early period of 
pregnancy, but in general, is not troublesome till towards 
the latter part. It consists of a sensation of burning pain 
in the stomach, with an eructation of a disagreeable acrid 
fluid, and commonly occurs in women who make use of 
heavy, indigestible food, fried dishes, alcoholic drinks, etc. 

In the treatment, a change of diet, exercise, purging, 
with slight counter irritation to the pit of the stomach, or 
a dose of magnesia, will often remove it ; also the sub- 
carbonate of soda and potash ; or n spoonful or two of 
lime-water, in half a cup of milk, two or three times a 
day, may be used. To these should be added a somewhat 
restricted diet of easily digestible substances, a residence 
in the country, .with moderate exercise, and bitter tonics 
when the stomach is enfeebled, with an occasional purge 
of rhubarb and aloes, or colocynth and emetics. • When 
alkalies fail, acids are often found to give relief. 

In addition to the affections of the stomach during preg- 



VARIOUS AFFECTIONS OF THE STOMACH. 323 

nancy now considered, we sometimes find others of a simi- 
lar character : indeed, we may have almost every variety 
and shade of affections ever met with in this organ ; such 
as dysphagia or difficulty of swallowing, characterized by 
spasmodic contraction of the esophagus ; hozmatemesis or 
vomiting of blood ; jaundice ; and finally, there may be 
every variety of dyspeptic symptoms. 

The treatment of these various affections is very sim- 
ple ; in general it is necessary to do little or nothing for 
them as they commonly cease after the fourth moruh of 
pregnancy : when some of these conditions of the stom- 
ach last longer, they seem to become the means by which 
nature prevents plethora, a state most likely to exist dur- 
ing pregnancy. The patient may, for the dyspeptic 
symptoms, employ bitter infusions, as gentian, camomile, 
wormwood, mint, and rhubarb, with a little wine, or mine- 
ral waters ; at the same time taking food only in small 
quantities, and of proper quality; also a few grains of 
nitre in lemonade, a little ether, or other antispasmodic, 
taken frequently and in small quantity. The difficulty 
of swallowing, if treated, may be met with counter irrita- 
tion by mustard, blisters, etc., and by antispasmodics as 
ether and fluid extract or infusion of valerian ; also by 
warm bathing. For the vomiting of blood, may be given 
slight astringents, with opium, purges and acids, with 
counter irritation (over the stomach) by blisters. For 
jaundice, the state of the stomach and bowels should be 
attended to on general principles — purging once in two or 
three days will be beneficial ; also alteratives, diapho- 
retics, opiates, and tonics, according to circumstances. 

GASTRALGIA AND CRAMP OF THE STOMACH AND BOWELS. 

This affection is characterized by acute pain in the re- 
gion of the stomach, and by a dragging sensation at the 
epigastrium, known also as nervous colic* It seems to de- 
pend upon an affection of the stomach and bowels brought 
on by errors in diet and mental emotion ; when violent, 
the patient is obliged to sit down, bend herself forwards, 
and press the epigastrium and bowels. It has sometimes 
caused abortion. (Burns.) 



324 CRAMPS OF THE STOMACH COSTIVENESS. 

The treatment does not much differ from some of the 
foregoing affections. During the paroxysm, a large flax- 
seed poultice, sprinkled with mustard, should be applied 
hot to the epigastrium. At the same time, a table spoonful 
of the extract or tincture of valerian, syrup of ether or 
poppey heads, opium, or some other antispasmodic, should 
be taken internally. The return of the paroxysm may 
be prevented by baths, enemata, warm and stimulating 
drinks, warm external applications, gentle purging, tonics, 
four t>r five grain doses of the sub-nitrate of bismuth, and 
the sub-carbonate of iron, with valerian. Finally, with 
these should be associated a regimen composed of ali- 
ments of easy digestion, which should be taken only in 
small quantities, with a little wine. Moderate exercise 
should be taken, and the whole habits of the patient must 
be properly regulated. 

CONSTPIATION OR COSTIVENESS. 

Constipation is a very common affection in pregnant 
females, and is generally caused by the pressure of the 
womb upon the intestines during the latter stages of preg- 
nancy ; it may also depend upon sympathetic irritation. 
When it exists to any extent, it produces loss of appetite, 
headache, indigestion, restlessness, sadness, sleeplessness, 
and capricious temper ; lastly, it may give rise to piles 
and even abortion. 

As to the treatment, we have already mentioned the 
most approved methods, at pages 224-28, Book I, to which 
the reader is referred. It is best always to avoid drastic 
purgatives, and depend upon a mild and laxative regimen. 
The following, from Colombat, embraces all necessary di- 
rections : white meats, dressed vegetables, particularly 
sorrel, lettuce, spinach ; cooked or very ripe fruits, such 
as cherries, melons, grapes, prunes, strawberries, and or- 
anges. We should add to. these, the employment of warm 
baths, the use of vegetable or veal soup, lemonade, or 
cream of tartar water, decoctions of tamarinds, prunes, 
etc., sweetened with honey. The bread of the patient 
should invariably be made from the unbolted wheat flour ; 
or Indian corn and rye may be used. 



DIARRHAGEA. DYSENTERY AND TENES3IUS. 325 

Should these measures fail, recourse must be had to 
emollient and laxative enemata of molasses or honey, with 
castor oil or senna, or suppositories. It may be necessa- 
ry to take internally, manna, castor oil, or Seidlitz pow- 
ders. Lastly, we should remark that sometimes the faecal 
matters become so impacted as to render it necessary to 
extract a portion of the mass with a scoop, spoon-handle, 
or the finger. 

DIARRHOEA, DYSENTERY AND TENESMUS. 

Although, as has been seen in the preceding section, 
the majority of pregnant women are more or less affected 
with constipation ; yet there frequently exists an opposite 
condition from about the same causes. Some are habitu- 
ally subject to diarrhoea or loose discharges from the 
bowels, others to periodical attacks of it, while again it 
may alternate or co-exist with constipation ; for we occa- 
sionally find the discharges fluid in consequence of irrita- 
tion in the lower portion of the intestines, while accumu- 
lations are taking place above it. When the evacuations 
are mixed with blood, it is called dysentery ; and when 
there is a constant and painful desire to go to stool, the 
affection is known as tenesmus. The last named condition 
depends upon the diarrhoea and dysentery ; and when ac- 
companied by fever and colic, has been known to produce 
abortion. 

Treatment. — When diarrhoea is slight and occurs at 
the commencement of pregnancy, the female retaining her 
appetite and strength, it may be treated simply by a care- 
ful diet, rice water and other bland articles, and emollient 
enemata. If it do not subside, a gentle purge of rhubarb 
and cream tartar may be taken, with baths, fomentations, 
and in severe cases the application of leeches to the anus ; 
or enemata with laudanum, and Dover's powders at night, 
and during the day tonic bitters, as gentian or camomile 
with a little ipecacuanha. If it run into dystentery the 
treatment must be more energetic ; while opium is given 
internally, or chalk mixture with kino or catechu, the diet 
should be simple as above ; or twenty drops of laudanum 
may be given in an enemata of starch and repeated several 



323 DIARRHCEA AND SANGUINE PLETHORA. 

times a day according to circumstances. When tenes- 
mus is present the treatment is the same. With the in- 
ternal use of the bitter tonics and ipecac, the greatest 
good is to be expected from a proper diet, such as rich 
soups, feculent substances, white meats, fresh eggs, and 
other substances easy of digestion ; at the same time the 
bowels must be kept free by the use of castor oil and 
emollient enemata. 



CHAPTER III. 

DISORDERS OF THE CIRCULATING SYSTEM CAUSES SYMP- 
TOMS AND TREATMENT. 



SANGUINE PLETHORA. 



We have elsewhere remarked that the general condi- 
tion of the system during pregnancy is that of 'plethora : 
some physicians have believed that this state is the sole 
cause of the diseases of pregnant women — which opinion 
to a certain extent only is true, as we sometimes observe 
the opposite condition. It seems to be caused by the 
direct effect and sympathy of the gravid uterus and the 
disorders of other organs, upon the circulation ; also, other 
causes which concur to produce it, independent of the 
menses, are the increased nutrition during gestation, a 
want of exercise, Md too much and too nutricious food. 

The symptoms of plethora are generally more marked- 
towards the sixth or seventh month ; they are fulness and 
hardness of the pulse ; the face is highly colored ; the 
lips, eyes and nostrils are red and injected ; the gums 
are painful ; the veins are swollen ; there is dizziness, 
ringing in the ears, bleeding at the nose, etc. 

The treatment, principally consists in the use of a 
vegetable diet containing but little nourishment ; laxa- 
tives, diluent drinks, emollient enemata, and moderate ex- 
ercise. When there is a disposition of the constitution to 
relieve itself by a discharge of blood from any part, bleed- 



VA^PtFAiZOn OF THE HEART FASTING. 327 

ing from the arm should be carefully employed, as the 
most dangerous consequences may be apprehended from 
hemorrhage in some vital organ. 

PALPITATION OF THE HEART. 

Most of women suffer at some period or other of their 
pregnancy from palpitation ; nervous and hysterical fe- 
males are the most subject to it, and the pulsations of 
the heart are sometimes so strong as to arouse the patient 
suddenly from sleep, or oblige her to stand still if she be 
walking. She feels the heart strike violently against the 
ribs which shakes the whole body ; sometimes there is a 
frequent and marked intermission ; the respiration be- 
comes named with giddiness, imperfect vision, and noise 
in the ears. The cause of palpitation depends upon a 
nervous constitution and sympathetic irritation of the ute- 
rus ; it is very often also, connected with plethora. The 
exciting causes are errors in diet, mental emotions and 
passions. It often constitutes a troublesome and painful 
inconvenience. 

Treatment. — During a paroxysm the patient should 
be placed in a position that affords the greatest relief; if 
there be much plethora, blood may be cautiously abstract- 
ed ; then she should be treated by antispasmodics, as 
opium, ether, and asafoetida. During the intervals atten- 
tion should be given to the bowels ; enemata, mild purging, 
tonics, a suitable diet, and moderate exercise in the open 
air, with an avoidance of tight dress and mental emotions, 
will much aid in relieving and restoring the patient. She 
should sleep with the head elevated, eat but moderately, 
and abstain from wine, tea, coffee, liquors, and all excit- 
ing articles. 

SYNCOPE OR FAINTING. 

Syncope consists in a complete and generally sudden 
loss of sensation and motion, with a suspension of respira- 
tion. It occurs most frequently at the time of quickening, 
' and sometimes periodically with an interval of se/eral 
days or weeks. The attack generally lasts only four or 



328 FAINTING DIFFICULT BREATHING. 

five minutes, during which the countenance, lips and 
mouth, lose their color, and there is a complete loss of con- 
sciousness ; it terminates by an insensible return of the 
respiration and pulse, when frequently the contents of the 
stomach are discharged. It seems sometimes to be a con- 
sequence of palpitation, and arises from the same causes 
carried further. It also sometimes results from plethora 
and the opposite state anemia ; motion of the child ; strong 
emotions ; sudden sounds ; certain odors, and tight dress. 
Treatment. — The woman should be immediately plac- 
ed in the horizontal posture, be relieved of all dress that 
might obstruct the motions of her breast, abdomen, neck, 
and limbs ; should be made to inhale strong odors, as of 
ammonia, burnt feathers, etc. ; frictions should be made 
over the region of the heart and other parts by dry cloths, 
or cloths wrung out of brandy or alcohol ; fresh air should 
be freely admitted, and cold water sprinkled on the face ; 
finally, sinapisms may be applied to the arms and legs. 
When she recovers her consciousness, she should swallow 
a little wine or other alcoholic drink diluted with water. 
During the intervals, the state of the bowels should be at- 
tended to, tonics and antispasmodics exhibited, with a 
light and nourishing diet ; also moderate exercise should 
be taken in the open air, and all exciting causes strictly 
avoided. 



CHAPTER IV. 

DISORDERS OF THE RESPIRATORY ORGANS CAUSES SYMP- 
TOMS AND TREATMENT. 



DYSPN03A OR DIFFICULT BREATHING. 

Difficulty of breathing may occur at any period of 
pregnancy ; first, in the early months from nervous irri- 
tation ; second, about the middle of gestation from ple- 
thora ; third, during the latter months from mechanical 
pressure of the gravid uterus against the diaphragm, 



DIFFICULT BREATHING COUGH. 329 

which is more common in women with narrow chests and 
contracted pelves. The presence of organic disease of 
the lungs may also give rise to it. The exciting causes, 
are excessive fatigue, mental emotions, and the impres- 
sions of certain odors. The oppression is sometimes so 
great as to produce a state bordering on suffocation, when 
the patient is obliged to maintain a vertical position, or 
place herself for relief on the knees upon cushions with 
the elbows on other and more elevated cushions, and in 
this way obtain sleep, or at least repose. 

Treatment. — During the early months of pregnancy, 
dyspnoea may be relieved by antispasmodics or diffusible 
stimulants, such as valerian, ammonia, ether, syrup of 
poppies, asafoetida, etc., with tonics during the interval. 
Wheji the attack arises from plethora, venesection should 
be resorted to, with purgatives, low diet and enemata. 
When it depends- upon mechanical pressure, the patient 
must take a position most favorable to respiration : to pre- 
vent suffocation, bleeding may be resorted to ; the food 
should be taken only in small quantities at each meal so 
as to prevent distending the stomach, while every thing 
difficult of digestion, and which produces wind, as well as 
all tight dress, must be avoided ; laxative drinks and ene- 
mata will be found useful in diminishing the size of the 
abdomen. Lastly, when organic disease of the lungs ex- 
ists, the treatment must have reference to such disease. 

COUGH. 

Freouently connected with the preceding described 
affection, but often independent of it, is a dry, troublesome 
cough, either constant or recurring in paroxysms, occa- 
sioning much distress. The cough which is peculiar to 
pregnancy, is of a nervous character, unaccompanied by 
mucous expectoration, occurs in the earlier months, and 
is caused by the sympathetic influence of the womb ; but 
there is another, much more dangerous, which it is import- 
ant to distinguish, produced by pulmonary engorgement 
or catarrh, characterized by mucous, and sometimes bloody 
expectoration, and often soreness of the throat; this may 
be caused in the earlier months by cold, and in the latter 

0* 



330 COUGH AND SPITTING OF BLOOD. 

by lessening of the thoracic cavity on account of the gra* 
vid uterus pushing up the diaphragm and intestines. The 
former is of little moment compared with the latter, whicb 
may give rise to fever, headache, haemoptysis, etc. In 
all cases, cough should be immediately attended to, as it 
may excite abortion, and determine or increase pulmonary 
inflammation. 

Treatment. — For the relief of the nervous cough, opi- 
ates and antispasmodics, with mild expectorants and 
counter irritation, will generally succeed. But when it 
depends on pulmonary engorgement, particularly if ple- 
thora be present, it will be necessary, in addition, to ab- 
stract blood. Mucilaginous drinks with syrup of poppies 
or morphine, Dover's powders and paregoric, with counter 
irritation, may be resorted to with success. The bowels 
must be kept free, by laxative enemata and aperients. 

HEMOPTYSIS OR SPITTING OF BLOOD, AND EPISTAXIS OR 
BLEEDING FROM THE NOSE. 

Haemoptysis, though a rare affection, sometimes occurs 
both in the earlier and latter months of pregnancy ; it is 
one of the most dangerous complications of the pregnant 
state. Women of sanguine temperaments, and those who 
wear tight clothing, are the most obnoxious to this affec- 
tion. There may be. an expectoration of blood simply, 
secreted from the bronchial, mucous membrane, which 
occurs more- frequently at the commencement of pregnan- 
cy, or, the blood may be derived from the rupture of some 
small arterial vessel in consequence of coughing while 
the lungs are engorged with blood ; or lastly, it may de- 
pend upon organic disease of the lungs, as phthisis. These 
latter kinds are always unfavorable to the patient, parti- 
cularly if she had been much troubled with cough before 
conception. This affection is to be distinguished from 
vomiting of blood, before adverted to, by the blood coming 
from the stomach being black, grumous and often mixec 
with the food ; while that which comes from the lungs, 
on the contrary, is vermillion in color, frothy and almost 
pure. 

Treatment. — This consists, first, in the emulovment oj 



TNS0MNIA OR SLEEPLESSNESS. 331 

bleeding and counter irritation, to relieve the local pie. 
thora ; and then in the use of opiates, and antispasmod- 
ics, as directed under the preceding affection, for the pur- 
pose of quieting the cough and irritation ; to these should 
be added astringent, cold and acid drinks, low diet, and 
perfect quiet, both of body and mind. 

Epistaxis, or bleeding from the nose, occurs more fre- 
quently in pregnant women than the preceding, but should 
be regarded rather as a healthful evacuation than as a 
disease. When it is excessive, however, it may be arrest- 
ed by keeping the head elevated and covered with cloths 
wet with cold water and vinegar, or by keeping the arms 
elevated, and applying cold between the shoulders. It is 
sometimes necessary to resort to plugging the nasal pass-, 
ages. 



CHAPTER V. 

DISORDERS OF THE NERVOUS SYSTEM AND SENSES. 



INSOMNIA OR SLEEPLESSNESS. 

Sleeplessness is one of the most troublesome com- 
plaints to which pregnant women are subject. It most 
often affects females of a nervous or hysterical habit, 
though it is sometimes the result of plethora : the latter, 
however, generally gives rise to the opposite condition or 
drowsiness. It may occur at any period of pregnancy, 
but is most common during the latter months, and seems 
often to be caused by heated rooms, too little exercise and 
motions of the child . If it continue for any great length 
of time, the stomach and bowels become deranged, and 
the patient complains of great weakness and misery. 
Sometimes the rest is disturbed by frightful dreams, and 
at others, the female is unable to sleep during the night, 
but obtains rest during the day ; this latter should not be 
confounded with the want of sleep. 



332 SLEEPLESSNESS DESPONDENCY. 

Treatment.- — This should be commenced by freeing 
the bowels, a soothing and light diet ; anodyne enemata 
may then be used, or, the fluid extract or tincture of va- 
lerian ; and in confirmed cases, small doses of morphine 
or some other opiate, may be taken at bed time. Spong- 
ing the whole body with cold water before going to bed, 
especially in warm weather, may be successful ; and 
lastly, if there be much weakness, tonics should be ex- 
hibited combined with sedatives and antispasmodics ;• or 
if there be much plethora, venesection should not be 
omitted. 



HYPOCHONDRIASIS OR DESPONDENCY, AND DISORDERS OF THE 
INTELLIGENCE, MORAL INCLINATIONS AND AFFECTIONS. 

Women of uncommon delicacy and impressionability, 
from ignorance of the condition of pregnancy and partu- 
rition which are only natural processes, and would always 
terminate favorably were nature allowed its course un- 
hindered, are apt to represent to themselves the most 
alarming danger ; the various symptoms that arise, cer- 
tain impressions made by hearing of the accidents of 
others, often excite fears of something being wrong, and 
anticipations of serious consequences, when in reality, 
there is nothing unusual, and not the least danger, if the 
patient but quiet her alarm. So that when a pregnant fe- 
male becomes melancholy and unhappy, which is often 
evinced by tears, we should sympathize with her, and 
moreover inform her the exact truth concerning her con- 
dition, lead the mind away from its morbid reflections, and 
comfort her affected sorrow with the blessings and joys 
which await her, when she will be " blessed among wo- 
rn-en," by becoming a mother. 

How deplorable, remarks Dr. Montgomery, must be the 
condition of the mind in a woman, who, led astray by the 
profligate from virtue's paths of pleasantness and peace 
and then abandoned, is compelled to consider her preg- 
nancy a curse instead of a blessing, and has, in addition 
to the ordinary troubles of that state, to bear up against 
the agony of disappointed hopes, of affections misplaced 
and cruelly misused, to endure the present srwn of socie 



DISORDERS OF THE INTELLIGENCE. 533 

ty, and the anticipation of a still increasing shame, for 
which she is to find no u sweet oblivious antidote" of pow. 
er to " pluck from the memory a rooted sorrow," or " raze 
out the written troubles of the brain !" How often has 
such a state of mind been followed by convulsions, or 
ending in insanity, has armed with the weapon of suicide 
the once gentle hand of her who, to use the words of W. 
Hunter, " might have been an affectionate and gentle wife, 
a virtuous and honored mother, through a long and happy 
life." Who can help being interested in such unfortunate 
beings, and instead of assisting in pushing them down- 
wards, of lending a helping hand for their consolation and 
restoration to happiness and joy ? 

Cases of disordered intelligence, and of the moral in- 
clinations and affections, are extremely rare, and have 
been greatly exaggerated : pregnant women have been 
known to become thievish, to have elevation of the intel- 
lect, becoming poetical or musical, while others have lost 
all intellectual activity. Goubelly knew a woman who 
never had a sound judgment except when she was preg- 
nant ; but she then lost her memory, which, after parturi- 
tion, she recovered but at the expense of no judgment. 
Baudelocque mentions one who ate nothing with so much 
pleasure as the articles of food that she had stolen, while 
going to market for her provisions. We have already ad- 
verted to the case of a woman who, taking a fancy to eat 
a piece of the flesh of her husband, whom she tenderly 
loved, assassinated him, and satisfying her depraved appe- 
tite, salted the rest for the purpose of prolonging the 
pleasure. Vives speaks of a woman who would, perhaps, 
have miscarried, had she not been allowed to bite a young 
man's neck, one of her acquaintances. Finally, Colom- 
bat speaks of a woman who threw three of her children 
into a well, and then plunged to the bottom herself; she 
had two absent children : happily for them, the youngest 
had not been sent to her in time, agreeably to her order, 
and the elder child did not eat any of the poisoned cake 
that she sent it. 

Treatment. — As to the moral management of the me- 
lancholic woman, the honest truth should be told her, 
concerning her suffering and danger, which is far more 
15* 



334 DISORDERS OF THE AFFECTIONS HEADACHE. 

effective than attempting to make light of her case. At- 
tention should be given to the bowels, exercise, cheerful 
society, and above all the female should be informed how- 
unfounded are her fears, and how much a happy termina- 
tion of parturition depends on a composure of mind. 
Generally,, the above noticed caprices and maniacal states, 
disappear after delivery without treatment. When there 
is congestion of the brain with a hot skin and quick pulse, 
no time should be lost in bleeding the patient, applying 
counter irritants, and purging her. 

CEPHALALGIA OR HEADACHE. 

Headache, next to nausea and vomiting, is, perhaps, the 
most common complaint of pregnant women. There 
are three varieties : the first is of a nervous character, 
arises in delicate constitutions, occurs in the early months 
from sympathy with the uterus, or may be brought on by 
vivid emotions of the mind and grief; the second depends 
upon plethora, occurs in robust constitutions and generally 
at a later period than the first ; the third variety depends 
upon disorder of the stomach or bowels, as constipation, 
which is caused by errors in eating and drinking. When 
the headache is purely nervous, there is little % danger ; but 
when it depends on congestion it requires immediate atten- 
tion, lest it give rise to convulsions. A temporary form 
of paralysis has been observed connected with the nervous 
variety. 

Treatment. — Nervous headache may generally be 
relieved by antispasmodics or diffusible stimulants ; such 
as valerian opium, camphor and ammonia, with laxatives 
or enemata and baths ; by eau de cologne applied to the 
head, and counter irritants ; and lastly, by rest and sleep. 
When there are symptoms of plethora the treatment should 
be active ; blood-letting and purgatives are principally 
relied on, and should be repeated until the pain be reliev- 
ed ; blisters to tne nape of the neck and enemata, are 
also, useful. The diet should be vegetable and mild, and 
the bowels kept in a soluable state ; air and exercise are 
also indispensable, particularly in the last named variety- 
with an avoidance of all stimulants and emotions. 



HEADACHE CONVULSIONS. 335 



PvUERPURAL CONVULSIONS. 



Convulsions may attack the female daring pregnane), 
parturition, and after delivery. We shall here depart 
somewhat from our proposed order, as it would be very 
inconvenient to describe in this place the convulsions of 
pregnant women, and those which occur during parturi- 
tion in another part of the work ; we shall therefore in- 
culde them all under this article. Convulsions, incident 
to the pregnant and parturient state a-re of three varieties, 
the hysteric, the epileptic, and the apoplectic. The hys- 
terical attack does not differ from that described in Book I. 
(See Chapter, X, Part IV.) 

Epileptic convulsions are much more frequent than 
either of the others ; according to the reports of several 
physicians in England, out of 38,308 cases of labor, there 
were 79 cases of convulsions ; or one in about 485. Wo- 
men of all temperaments are subject to the attack, but 
the sanguine and those with their first children, particu- 
larly those with short necks, and of short, square forms,- 
are the more liable. (Collins.) First among the causes of 
these convulsions is the irritation of the uterus, which be- 
stows power upon many other causes that in the common 
course of life give a predisposition to convulsive disorders, 
but would not alone, always produce them : women in 
their first pregnancy ; those of plethoric constitutions, or 
who have rachitic and deformed systems ; those who are 
intemperate in eating and drinking, or the use of stimu- 
lants ; those who wear tight dress or corsets, and give 
themselves up to venereal pleasures, passions and emotions 
of the mind ; and, in fine, those who, in any way trans- 
gress the laws of hygiene, and thus engender an irritable 
condition of the system, are most subject to this formida- 
ble affection. Convulsions may also be prodced by severe 
labor, pains, lacerations, exposure to cold, and walking 
about too soon after delivery ; they are also, sometimes, 
brought on by the power of imitation, or from fright by 
seeing another affected. 

The symptoms are almost identical with those of ordi- 
nary epilepsy. After a premonitory stage, longer or 
shorter, of headache, ringing in the ears, obscure vision, 



338 PUERPURAL CONVULSIONS. 

giddiness, flushed face, temporary loss of sensation, nau- 
sea and vomiting, the patient loses all consciousness ; the 
countenance assumes a bluish tint, the eye becomes fixed, 
the angles of the mouth are drawn backwards, there is a 
discharge of froth, the hands are clenched, the body be- 
comes rigid, the head turns over backwards, and the 
tongue is protruded through the half-open mouth ; the 
respiration which at first was hurried, becomes suspended 
and the action of. the heart sometimes almost entirely 
ceases. The duration of the attack varies from three to 
five and even ten minutes, when the respiration and cir- 
culation gradually resume their natural course, the ri- 
gidity is followed by complete relaxation-»-and accom- 
panied by stertorous breathing and moanings, conscious- 
ness is gradually restored without any recollection of 
what transpired during the paroxysm. It almost always 
happens that there is a repetition of the attack — the fre- 
quency of which increases the danger — the torpor and 
sleep being prolonged in proportion as they are more 
frequently repeated ; in some cases, they recur at deter- 
minate periods. 

Death sometimes takes place during the convulsion, or 
the stupor which follows it ; and when the woman sur- 
vives, the life of the child is endangered : the 'prognosis is 
always very serious, as it is liable to give a permanei: 
shock to the brain or nervous system. 

Apoplectic convulsions, rarely or never occur exce 
towards the termination, or after the conclusion of labor, 
and they are then, as we have remarked, very rare. 
They arise from about the same causes as the preceding 
variety. There may occur nearly the same premonitory 
symptoms, but the convulsions are much less marked ; 
there is no frothing at the mouth, little or no distortion of 
the face, and the patient lies in a torpid state, with sterto- 
rous respiration and flaccid muscles, from which she 
rarely recovers. 

Treatment. — At whatever time the attack takes place, 
all physicians are decided upon the propriety of immedi- 
ately letting blood in large quantity, which is to be re* 
peated according to circumstances ; leeches may also be 
employed. At the same time cold water is to be poured 



NERVOUS AFFECTION OF THE EYES, ETC. 337 

upon the face, while the patient should be properly held 
by assistants, without violence ; the tongue, when pro- 
truded, should be pushed back into the mouth, and a piece 
of fine cork may be made use of to retain it there, lest it 
be seriously lacerated. Great benefit will be derived 
from the administration of a strong purgative, for exam- 
ple, calomel and jalap; if they cannot be given by the 
mouth, enemata should be resorted to. Emetics should 
not be prescribed, unless the convulsions depend upon an 
overloaded stomach. Cold should be applied to the head 
by a bladder filled with ice, and the patient put into a 
warm bath, if there be one at hand. After the lapse of 
some time, blisters may be applied to the neck and ex- 
tremeties ; this is particularly necessary when the stupor 
is prolonged ; they should, however, be removed before 
vesication takes place. Finally, after the paroxysm has 
somewhat subsided, an opiate, combined with an antispas- 
modic, may be given. This mode of treatment applies 
whether the convulsions occur previous to, during, or aftei 
labor. The process of gestation or parturition, need not 
be interfered with more than usual, unless there be some 
particular indication for such a course ; when the woman 
is in labor, however, it is always desirable to effect de- 
livery as soon as practicable. 

NERVOUS AFFECTIONS OF THE EYES AND EARS. 

When" we consider the many irritations that arise in 
different parts, during pregnancy, it is not surprising that 
the eyes and ears should not escape. When the eyes are 
affected, it appears to the patient as though surrounding 
objects were moving in various directions, or she fancies 
that she sees objects in the air, flashes of light, and a 
great variety of imaginary forms ; she sometimes sees 
every thing double, or lastly, vision becomes indistinct or 
is entirely lost. The sense of hearing may become ob- * 
tuse, either in one or both ears, or, on the other hand, it 
may be more acute than usual ; there may be singing 
and other noises in the ears, or, lastly, the sense of hear- 
ing may be entirely lost. There may be also derange- 
ment of the sense of smell. In the majority of cases 



338 HEMORRHOIDS OR PILES. 

these various affections are purely nervous ; but they 
sometimes depend upon plethora or congestion of the brain. 
They are generally merely temporary. 

Treatment. — When they are nervous, very little need 
be done ; the bowels should be attended to, a small blister 
may be applied behind the ears, and antispasmodics, as 
valerian, united with tonics, and sometimes opiates may 
be prescribed with benefit. The diet should be mild and 
vegetable, with an occasional enemata. If there be evi- 
dence of congestion, blood-letting will be necessary, the 
application of leeches, and one or two brisk purgatives. 



CHAPTER VI. 



DISORDERS ARISING FROM MECHANICAL PRESSURE OR DIS- 
TENSION. 

Under this chapter should be arranged, when they oc- 
cur during pregnancy, hernia of the womb, prolapsus, 
retroversion and anteversion, obliquity, etc., which we have 
treated of in Part IV. Book I. of this work, to which the 
reader is referred. 



HEMORRHOIDS OR PILES. 

We have already treated of this disease in Chapter VI. 
Part IV. Book I. ; as the symptoms and treatment are the 
same when the affection arises during pregnancy, a pro- 
longed description here is unnecessary. The disease oc- 
curs most often in women of a feeble and lymphatic con- 
stitution, during the latter stages of pregnancy, and is 
caused by the pressure of the gravid uterus ; it also 
arises in the early months from the use of drastic purga- 
tives, errors in diet, and constipation. There is frequent- 
ly considerable fever, tenesmus, bleeding and excoria- 
tions j the disease is a source of great suffering, and may 
be so severe as to produce abortion. 

Treatment. — First, the bowels should be freed by a 
mild laxative, as sulphur and cream tartar, or electuary 






INCONTINENCE AND RETENTION OF URINE. 339 

of senna, after which, anodyne enemata may be used, and 
leeches applied around the anus ; emollient and narcotic 
fomentations and ointments are also very useful. The 
diet should be liquid, and the drinks cooling. To check 
the bleeding, if profuse, astringent fomentations and injec- 
tions, pressure, and plugging the rectum, should be resort- 
ed to, according to circumstances. (See Chapter VI. 
Part IV. Book /.) 

INCONTINENCE OF URINE. 

By this term is understood an inability to retain the 
urine ; there is a frequent and painful desire to discharge 
the water, and, if not instantly gratified, it is passed in- 
voluntarily. The patient's sufferings are often intense 
from scalding, itching, and pain of the external parts. 
Incontinence arises during the early months from irrita- 
bility, in consequence of the sympathy of the uterus ; at 
a later period, it is owing to the pressure of the enlarged 
uterus upon the bladder. 

Treatment. — During the early months, the bowels 
should be kept free, leeches may be applied to the lower 
part of the abdomen, or warm anodyne fomentations, which 
often, alone, give relief. At the same time opium or 
hyosciamus may be given internally, with mucilaginous 
drinks ; injections of a solution of borax or alum, are, 
also, often very useful. At a later period, little can be 
done, except to await patiently the termination of gesta- 
tion ; cold, local sponging may be useful, 'and when ex- 
coriations arise, they are to be treated with mucilaginous 
fomentations and astringent lotions. Gentle laxative med- 
icines and enemata should be occasionally exhibited. The 
diet should be vegetable and unstimulating. 

DYSURIA AND RETENTION OF URINE. 

There may be a difficulty in voiding the urine, or it 
may be impossible to evacuate it from the bladder ; this 
may occur either during the early or latter months of 
pregnancy. In the early months, it is caused by a sym- 
pathetic irritation of the neck of the bladder, and after- 



340 DISTENTION OF THE VEINS. 

wards, by the pressure of the uterus upon the same ; it 
may also be caused by displacement of the uterus. 

Treatment. — When dysuria arises from irritation, re- 
lief may be obtained from the application of leeches, from 
anodynes, mucilaginous drinks, and warm fomentations. 
When the retention depends upon compression, it may 
sometimes be avoided by changing the position ; if it be 
complete, the catheter 'must be used, and repeated as fre- 
quently as may be necessary. Attention should also be 
given to the bowels and diet. 

VARICOSE OR DISTENDED VEINS. 

. Dilatation of the veins, though not a very dangerous 
or troublesome affection, is one of the most frequent to 
which pregnant women are subject. It is found most of- 
ten during the latter half of gestation, and generally af- 
fects the veins of the lower extremities, and more rarely 
those of the labia majora, the vagina and mouth of the 
uterus ; occasionally the veins of the whole body are im- 
plicated. It generally affects one side more than the 
other, and occurs, mostly, in women of a lax and plethor- 
ic habit ; the principal if not sole cause, is the pressure 
of the gravid uterus upon the large venous trunks of the 
body. Varicose veins appear under the form of indolent, 
oblong, round and uneven knots, which generally disap- 
pear under pressure, but immediately return again ; they 
diminish by rest in bed, and increase upon resuming a 
vertical posture. The bleeding from rupture of a small 
varicose vein is easily suppressed by pressure, but not al- 
ways so when it occurs in a large vessel. After delivery 
the veins gradually return to nearly their natural size, 
' unless the disposition to the affection be kept up by re- 
peated pregnancies. It should be remarked that there is 
a great liability to inflammation of a portion of these veins 
after delivery. 

Treatment. — The affection cannot often be cured till 
after delivery, when it generally subsides spontaneously. 
The disposition to it, however, may be lessened by keep- 
ing the bowels in a soluable state, by rest in the horizontal 
posture, and by means of a laced stocking or bandage 









DROPSY DURING PREGNANCY. 341 

firmly applied in the morning when the veins are least 
distended. When but one limb is affected, the patient 
should recline on the opposite side ; when the rupture of 
a vein takes place, firm pressure will generally control the 
hemorrhage; the diet should be mild, and constipation 
carefully avoided. If the affection persist after delivery, 
the resources of surgery are generally successful in giv- 
ing relief. 

(EDEMA, ANASARCA AND ASCITES, OR DROPSY DURING PREG- 
NANCY. 

(Ebema or anasarca, signifies a dropsical state of the 
lower extremeties ; while by ascites is understood, dropsy 
of the abdomen : the former generally exists with the lat- 
ter, but often exists independently of it ; and occasionally 
there is an edematous state of the whole body. Dropsy 
is most common in women of a feeble and lymphatic body, 
and is caused by the pressure of the gravid uterus during 
the latter months of pregnancy ; there is also another and 
more active kind depending upon plethora. It is often 
confined to the feet and legs, but is liable to involve the 
thighs, vulva and hips. The limb appears swollen, semi- 
transparent, pits upon pressure, increases towards night, 
and is found diminished in the morning. That which 
arises as the consequence of pregnancy is not dangerous, 
and disappears after parturition ; it gives rise merely to 
sensations of weight, and when the effusion is extensive, 
interferes with sitting and walking. Sometimes, however, 
there is fever with much tenderness, and an attack of 
erysipelatous inflammation may end in abscess. 

When oedema is complicated with ascites or effusion 
into the abdomen, which is rare, all the symptoms pecu- 
liar to abdominal dropsy will be present, which is liable 
to interfere with the development of the ovum. 

Treatment. — For dropsy dependant on pressure, it 
will perhaps be sufficient to keep the bowels in a soluable 
state by mild purgatives, to which diuretics may be 
ttdded, with rest in the horizontal posture. Dry firictions 
and arromatic lotions as well as gentle compression by a 
roller bandage, may, also, be tried. When the swelling 
16 



34i JPAINS IN THE BREASTS, AND OTHER PARTS. 

is large and where the size of the labia offers an impedi- 
ment to labor, and particularly when abscess is aprehend- 
ed, the fluid should be evacuated with the point of a 
lancet ; if an abscess form, it must, also, be punctured. 
When the dropsy is general and accompanied by fever, 
the treatment must be more active ; brisk purging and 
blood-letting are to be principally relied on. On the con- 
trary, when the patient is feeble and debilitated, a gene- 
rous diet and tonics will be necessary. Lastly, when 
there is dropsy of the abdomen, it is sometimes necessary 
to resort to tapping. 

PAINS AND CRAMPS IN THE BREASTS AND OTHER PARTS, 
DURING PREGNANCY. 

The breasts of some women, on account of the sympa- 
thetic influence of the uterus, become painful and swollen 
in the early months of pregnancy; in others, pains come 
on towards the close of gestation from the distention of 
the skin from secretion of milk. These pains, generally, 
require no medical treatment ; in the more serious ones, 
however, relief may be obtained from applying warmth, 
emollient fomentations, and opium or belladonna plasters. 
The bowels should be attended to, and all the habits of 
the patient carefully regulated. 

Cramps and irregular pains in various parts of the lower 
half of the body are not uncommon in pregnant women 
during the time intervening between the fourth month and 
delivery ; they attack the sides, back, abdomen and low- 
er extremeties, being caused by the pressure of the gravid 
womb upon the nerves or stretching of the ligaments. 
They sometimes commence by a sensation of numbness 
or pricking, and are very severe : when they come on 
suddenly, they cause the patient, sometimes, to fall. 
These pains, no doubt, are increased by deranged diges- 
tion, constipation, fatigue, mental irritation, etc. 

Treatment. — The patient may often find relief by 
assuming the horizontal posture, and by rest ; also, by 
friction with some stimulating lotion ; the application of 
anodyne plasters, or opium internally ; baths ; a flannel 
bandage to support the abdomen ; by attention to the con- 



AFFECTIONS OF THE GENITAL ORGANS. 313 

dition of the stomach and bowels ; and finally, by patience, 
which is quite as important a remedy as any other — for 
these affections are ail temporary, and terminate with the 
pregnancy. 






CHAPTER VII. 

DISEASES OF THE GENITAL ORGANS DURING PREGNANCY. 

There are several affections to which the reproductive 
organs are obnoxious during the pregnant state, the man- 
agement of which does not differ from that already men- 
tioned for their occurrence in the unimpregnated condition ; 
we here mention them for the purpose of including all the 
diseases of pregnancy and thus making this part of our 
subject complete. Such are uterine hemorrhages oc- 
curing during pregnancy, which are less dangerous to the 
mother than to her child ; for the treatment, see chapters 
on Abortion and Menorrhagia, 

Pruritus or itching of the vulva is not of unfrequent 
occurrence, as we have already remarked; see Chapter 
VI., Part II. , Book I. 

(Edema of the labia sometimes occurs independently 
of dropsy of the lower extremeties, but is oftener associated 
with that affection, and is produced by the same causes : 
the management does not differ from that directed in the 
preceding chapter for dropsy during pregnane!/. 

Vaginal leucorrhea may be excited during pregnancy 
by any of its ordinary causes, but in addition by the irri- 
tation of gestation : see Chapter on Leucorrhea, Part IV., 
Book I. Discharge of watery fluid, requires much 
the same management. 

Inflammation and rheumatism of the pregnant ute- 
rus, are produced by the same causes as in the unimpreg- 
nated state : for the treatment of the former see chapter on 
Inflammation of the Unimvregnated Uterus ; for the latter 
see chapter on Irritable Uterus. 

Menstruation during pregnancy is a very rare occur- 
rence : females are stated to have menstruated once or 
twice after conception, during the fivsi four, five and six 



344 AFFECTIONS OF THE GENITAL ORGANS. 

months, and even throughout the whole period of gesta- 
tion ; and what is still more remarkable and rare, women 
have menstruated during pregnancy and at no other time. 
These occasional occurrences are well established by 
acute observers and physicians of eminence, but they may 
be regarded as departures from the normal course of na- 
ture ; thedischarge may proceed from the lower portion of 
the uterine cavity before the ovum is sufficiently large to 
fill it, or from the vessels of the neck, or from the vaginal 
mucous membrane. 

It, in general, requires no particular medical treatment ; 
it may be well for the patient to preserve the recumbent 
posture during the continuance of the discharge, for the 
purpose of guarding against miscarriage ; her clothing 
should not be too warm ; her diet should be moderate but 
not stimulating, and her occupations cheerful ; in fine, in 
this, as well as all the affections of pregnancy, let the 
female guard her interesting condition against the evils to 
which she is obnoxious, by an appropriate system of phy- 
sical and mental hygiene. 



PART II. 

the Physiology and diseases of childbirth. 



SECTION I. 
PHYSIOLOGY OF CHILDBIRTH. 

"VThen pregnancy has passed through all its stages, ac- 
cording to the design of nature, and the foetus has attained 
its last, and a sufficient degree of maturity, to enable it to 
exist independently of the mother, " the birth of man takes 
place ;" the phenomena attending the expulsion of the 
foetus from its maternal connection, which may be likened 
to the effort by which a tree casts off its fruit when fully 
ripe, is called childbirth, parturition, or labor. This, as 
has already been seen, generally, occurs at the end of 
nine calendar months and a week — ten lunar months — 
forty weeks, or 280 days : a few days may be allowed 
either way. 

If labor take place at the time here indicated, it is said 
to be at term; if pregnancy extend beyond this period, it 
is said to be tardy or retarded ; if it take place between 
the seventh and ninth month, it is known as 'premature or 
precocious ; finally, if it occur before the seventh month, 
it is called miscarriage or abortion. Labor, in all these 
cases, is accompanied by about the same phenomena. 

345 



CHAPTER L 



THE CAUSES OF LABOR. 



Hippocrates, with all the ancients, believed that the 
child was born by its own efforts. Numerous opinions, 
respecting the cause of labor, were formerly held, which 
have no connection whatever with the true cause. An 
Arabian physician of the eleventh century, contents him- 
self by saying : " At the proper time, labor comes on at 
the command of God ;" and in modern times, a physician 
of our own country, remarks : " We know no more of the 
immediate, exciting cause of labor, than we do why straw- 
berries ripen in June, and peaches in August. It is a law 
established by the Creator : that is all we know about it." 

But while the exciting or determining cause of labor 
yet remains unknown, the same periodicity which char- 
acterizes the other uterine functions, is observed here also. 
Abortion and premature labor, when not the result of ac- 
cident, generally occur at what, but for conception, would 
have been a menstrual period. It has been remarked by 
Stark and others, that the normal period for childbirth, 
also, corresponds to a menstrual period ; and it is well 
established, that labor takes place at about the tenth peri- 
od after the last appearance of the menses — there being, 
sometimes, a variation of a few days, which depends up- 
on, whether conception took place immediately before or 
after menstruation. 

We know, from direct observation, that the efficient 
cause of labor, is principally constituted by the contrac- 
tions of the uterus. If the hand be applied over the 
womb during a pain, its contractions may be distinctly 
felt ; when, from necessity, we are obliged to introduce 
the hand into the cavity of the uterus, it often happens 
that we are compelled to suspend progress during each con- 
traction ; and sometimes the hand of the operator, for a 

346 



THE PHENOMENA OF NATURAL LABOR. 347 

short time, becomes "paralyzed, losing all power, and is 
soon forcibly expelled. Several cases are reported, in 
which pregnancy occurred in a prolapsed womb, and the 
labor terminated spontaneously, while the uterus was be- 
tween the thighs of the mother. Though it is seen by 
these examples that the contractions of the uterus are suf- 
ficient for the expulsion of the child, nevertheless, in most 
cases the womb is sustained and assisted by the action of 
the diaphragm and abdominal muscles. 

The function of parturition is almost entirely involun- 
tary ; many women have been unconsciously delivered, 
by spontaneous efforts alone, while in a deep sleep, or 
lethargy, produced by criminal attempts. A female may, 
however, by the power of the will, retard or delay labor 
for a few hours, and in this sense, it may be considered 
partially voluntary, like unto the excretion of stool, and 
the emission of urine ; so, also, on the contrary, a woman 
who bears down, or enforces her pains will sooner get rid 
of the product of conception. 

When the womb has reached its enormous and last de- 
gree of distention, it, by gradual and slight contractions, 
dilates its neck ; when the orifice is sufficiently large, the 
uterus, redoubling its own efforts, rarely fails to receive 
the assistance of all the muscles of the body, and particu- 
larly of the diaphragm and abdominal muscles. 



CHAPTER II. 

THE MECHANISM AND PHENOMENA OF SPONTANEOUS OR 
NATURAL LABOR. 

The term natural labor has been applied, by some 
authors, to those cases in which the head of the child pre- 
sents, and the process is concluded, in due time, by the 
unaided powers of nature, with safety to the mother and 
child ; other authors have classed, as spontaneous, all la- 
bors that terminate under the sole influence of the powers 
of the organism, whether the head present ; the breech, in- 
cluding the hips and loins ; the inferior extremeties> in- 



349 THE PHENOMENA OF natural labor. 

eluding the knees and feet; the superior extremities^ 
including the shoulder, elbow and hand ; or other presen- 
tations, such as the back, abdomen, sides, etc., which are 
extremely rare. On the contrary, those labors that are 
difficult, in any way endangering the life or health of the 
mother or child, are known as difficult, troublesome or 
complicated. 

Notwithstanding, the latter classification would seem to 
be more philosophical and convenient, there is no denying 
that the head of the child ought to present and be deliver- 
ed first; and that when any other part descends first, it 
may, strictly speaking, be regarded as unnatural ; yet in 
any of the presentations above noticed, the labor may be 
spontaneous and' fortunate. We shall, however, follow 
this division, as it is believed that all discrepancy disap- 
pears by substituting the word spontaneous for natural. 
Any part of the head may present, constituting a variety 
of positions, and the same may be said of the other pre- 
sentations, which it is not necessary for us to dwell upon. 
Head presentations form a very large proportion of the 
sum total ; out of 20,517 cases of labor, recorded by 
Madam Boivin, there were 19,810 head presentations, 372 
breech presentations, 238 of the inferior extremeties, and 
80 presentations of the superior extremeties. 

In order that a labor may be spontaneous, or terminate 
without foreign aid, perfection of form and a healthy con- 
stitution, are requisite on the part of the woman ; and on 
the part of the child, it is important that it be normally 
developed, that one of its extremeties present, and that it 
be not of a size disproportioned to the. capacity of the pel- 
vis. Notwithstanding the number of these conditions, 
difficult parturition is comparatively rare ; while sponta- 
neous childbirth constitutes a very large proportion of the 
whole number of labors. Out of* 20,357 labors that took 
place at the Maternite of Paris, 20,183 were brought to a 
conclusion by the hand of nature alone. 

The mechanism of labor is an ingenious contrivance, 
and consists in the application of mechanical principles to 
the accomplishment of delivery. The child, instead of 
descending in a strait line from the uterus, as might be 
supposed by ©ne unacquainted with the anatomy of the 



THE PHENOMENA OF NATURAL LABOR. 349 

parts, lias to pass through a crooked, bony canal ; it, in 
fact, during its passage, describes a perfect half circle. 
When the head presents, it enters the brim of the pelvis 
diagonally, with the vertex turned towards one acetabulum, 
generally the left ; after, in this manner, passing through 
the superior strait, it makes a quarter turn, so that the 
face lodges in the hollow of the sacrum ; this motion 
brings the long diameter of the foetal head to correspond 
with the long diameter of the outlet, which is exactly the 
reverse of that of the superior strait. The head now 
passes the inferior strait, (at the same time the shoulders 
are passing the superior) when it makes another quarter 
turn so as to bring the long diameter of the shoulders to 
correspond with that of the inferior strait. And thus this 
spiral progression continues, from the moment the head 
engages in the superior strait, until the body of the child 
is expelled from the mother. 

For the convenience of description, it is customary to 
divide the process of labor into stages, some making more, 
and others less : we shall make three stages. The first, 
extending from the commencement of labor to the com- 
plete dilatation of the mouth of the uterus ; the second, 
ends with the delivery of the child ; the third, is occupied 
by the expulsion of the afterbirth. Another period may 
be added, called the 'preliminary signs of labor. 

The preliminary signs, in some women, are scarcely 
noticed ; in others they are but slight, while in many they 
are well marked. From two to fifteen and even twenty 
days before parturition, the abdomen diminishes in size, 
from sinking down of the womb ; the motions of the child 
are increased ; the external labia become swollen, and 
sometimes painful ; the respiration, appetite and digestion 
are better; the female regains her former gaiety, is more 
disposed to activity, and is often induced to believe that 
her term is further off than she had supposed. There is 
a sense of weight in the pelvis, a frequent disposition to 
stool, and to void the urine, caused by the pressure of the 
uterus ; the pelvic cavity becomes relaxed and softened ; 
there is a more active secretion of mucus in the genital 
passages, and a glairy matter, more or less abundant, 
escapes from the vagina. 



350 THE PHENOMENA OF NATURAL LABOR. 

Towards the close of gestation, there is painless con- 
traction of the uterus, by which the neck of that organ 
becomes insensibly dilated. Sometimes, however, from 
over-fatigue of the patient, indigestion, constipation, cold, 
etc., these contractions become painful, simulating the 
pains of labor ; they are known as false or spurious pains, 
and may occur at any period of gestation, but are not 
common until towards its termination. They may be dis- 
tinguished from the true pains by the following differen- 
ces : they commence in the upper part of the abdomen, 
are of limited extent, recur at irregular intervals, but are 
not attended with the glairy mucous discharge, do not di- 
late the mouth of the uterus, or protrude the bag of waters ; 
true pains, on the contrary, are accompanied by phenome- 
na quite the reverse of this. These pains should be treat- 
ed by aromatic purgatives, sedatives, and by regulating 
the habits of the patient. 

The first stage of labor, at length, begins: it ia 
marked by slight colic pains, which gradually, and at con- 
siderable intervals, become more intense ; the external 
genitals are moistened by the secretion of glairy mucus. 
The pains now increase, while the womb contracts, com- 
pressing the foetus, and forcing it downwards. The 
woman is now frequently troubled with evil forebodings ; 
she becomes low-spirited, loses all courage, weeps, and 
sometimes says she is going to die. It is said that animals, 
also, fall into this state of fear at the commencement of 
labor, refuse to eat and drink, seeming to be occupied with 
some threatening danger. 

The pains not only increase in severity, but at the 
same time become longer and more frequent ; the dis- 
charge of mucus increases, and streaks of blood are found 
mixed with it ; the mouth of the womb by degrees dilates, 
and the lower portion of the foetus is protruded into the 
upper part of the vagina, and is known as the bag of wa- 
ters ; the woman becomes irritable, impatient, and difficult 
to control ; the pains are preceded by rigors, there is heat, 
quickness of the pulse, a flushed face, aud great thirst; 
nausea, vomiting, and cough ; and in irritable women, the 
anguish and restlessness are so great as to resemble deli- 
rium. When a contraction is over the restlessness ceases. 



THE PHENOMENA OF NATURAL LABOR. 351 

the mouth becomes moist, the pulse, the skin, and in fine, 
everything, returns to its natural state ; the bag of waters 
has returned into the cavity of the uterus; and though 
the nausea is suspended, the abdomen, often remains more 
or less tender. Each pain produces the same series of 
phenomena, but the remission, which grows shorter and 
shorter, is more complete. The mouth of the uterus, 
gradually yields, and becomes sufficiently dilated for the 
passage of the child's head, which terminates the first, the 
longest, and most fatiguing stage of labor ; though not 
always the most dangerous. 

In the second stage of labor, the contractions become 
stronger, last for a longer period, are not so far apart, but 
are followed by a more decided calm. The courage of 
the woman returns, and they sometimes sleep during the 
short interval between the pains. The bag of waters be- 
ing more and more compressed in the upper part of the 
vagina, at length, in the midst of one of the most violent 
pains, bursts ; and the child, forced downwards by the 
same contraction, takes the place of the membranes and 
prevents the escape of the rest of the waters. Soon, the 
pains succeed each other with greater rapidity, each one 
being ushered in with a shiver ; the severest ones are 
often preceded by another which is milder ; or they may 
alternate with each other. The woman, now, almost in 
spite of herself, is compelled to second her pains by con- 
tracting the abdominal muscles, and making the most 
violent efforts ; she lays hold of the sides of the bed, or 
anything within her reach, plants her heels upon the 
matress, draws a long breath, and contracts the muscles 
of the abdomen with her whole power while the dia- 
phragm is pushed downwards with great force, and all the 
muscles of the body act with the same energy ; the neck 
and face become engorged with blood, the eyes sparkle, 
sweat pours from the skin, and at length this great con- 
traction ends in rapid sobs, which soon restore calmness. 

After a short time another pain comes on, followed by 
the same phenomena ; and soon again, another, which is 
somewhat stronger, and pushes the head of the child into 
the vagina ; the bearings-down are now redoubled ; there 
are cramps in the thighs and legs ) the vagina is unfold- 



352 'THE PHENOMENA OF NATURAL LABOR. 

ed and enlarged in every direction. As the head ap- 
proaches the inferior strait, the coccyx is pushed back- 
wards, the perineum is elongated and becomes thinner, the 
labia are put on the stretch and completely unfolded : na- 
ture now rallies her remaining muscular power, and by a 
few contractions, still more powerful than the former, tri- 
umphs over all resistance, and the head, or presenting 
part, escapes through the vulva ; this is followed, gener- 
ally after a few minutes, by the body of the child, which 
is expelled by a moderately strong contraction. The 
second stage is now finished, and the state of intense suf- 
fering is exchanged for perfect ease. 

The third stage of labor includes the detachment and 
expulsion of the placenta or afterbirth. In mo.°t rases it 
is partially or whollv detached by the same contractions 
which expel the child, remaining in the uterus or vagina ; 
sometimes, however, it is expelled with the child. In the 
former case, after an interval, varying from a few min- 
utes to an hour and a half, the average being fifteen or 
twenty minutes, the uterus again actively contracts, but 
much less forcibly, and expels it along with a gush of 
clots of blood. 

The labor is now concluded. One of the most melting 
scenes, remarks Velpeau, a scene best adapted vividly to 
affect the human heart, is presented to the eyes of the 
philosophical accoucher. To those piercing cries and vio- 
lent agitation, to those transports of despair, those exces- 
sive efforts, which seem to be intolerable, instantly suc- 
ceeds a delicious calm, full of charms, and interrupted 
only by the happy idea of being a mother. The new- 
born child cries, and all the sufferings of the mother so 
courageously borne, are forgotten ; passionate expressions 
of satisfaction are substituted for those of pain ; sobs of 
happiness succeed to the sobs of despair ; and this sudden 
transition from the extremest dread, from a frightful state 
of anxiety, to the height of joy and of the tenderest affec- 
tions, is, in sensible, amiable women, one among those 
appearances which most imperiously demand our admira- 
tion for a sex whose other claims to it are so numerous ! 

We should remark, that the foregoing phenomena are 
not found in all women, or in all labors of the same 
women ; but chiefly in those who are young, vigorous, 



THE PHEX03IENA OF NATURAL LABOR. 353 

and in labor for the first time : in different cases are found 
a great variety of appearances. 

The duration of labor is much shorter in savage than 
in civilized life ; in hot, than in cold countries. Labor, 
in this country, lasts from four to eight or twelve hours ; 
the average term may be stated at from four to six hours. 
Out of 15,850 cases recorded by Dr. Collins, of England, 
13,012 were terminated at the end of six hours, 2,072 re- 
quired twelve hours, 262 eighteen hours, 240 twenty-four 
hours, and 264 required for their termination over twenty- 
forr hours. 

The most essential phenomena of labor require further 
notice : they are, as has been seen, the contraction of the 
uterus, or pain, the dilatation of the neck, the formation 
of the bag of waters, and the discharge of glairy rnucus. 

Labor-pains. Common use has rendered the word pain 
synonymous with uterine contraction ; and although it is 
true that they begin, progress, and cease together, and that 
it is generally by the pain that we estimate the strength of 
the contraction, yet we are sure that the one is not wholly 
dependent on the other. For, although, no labor can be 
terminated without contraction on the part of the uterus, 
it is known that many have taken place without pain. The 
pains, at first slight, and known as little 'pains, commence 
in the loins, gradually extend round to the abdomen, and 
down the thighs : when the labor is fairly set in, they are 
known as grinding pains. During the first stage, the ac- 
tion of the womb is involuntary, and it can receive no as- 
sistance from bearing-down efforts till the foetus be forced 
into the cavity of the pelvis. During the second stage, 
however, nature employs all her efforts for the expulsion 
of the child ; the pains now are changed in character, and 
are known as great or bearing-down pains. At first, each 
pain continues less than half a minute, and the interval of 
calm is about fifteen minutes ; towards the close of labor, 
however, the duration of the pain increases to a minute 
or a minuce and a half, while the interval of calm is re- 
duced to four or five minutes. 

The cause of labor pains has been supposed to be the 
contractions of the uterus : they have also been attributed 

r* 



354 THE PHENOMENA OF NATURAL LABOR. 

to other causes. But the majority of writers at the pre- 
sent, day are of opinion that no normal muscular contrac- 
tion was designed to give rise to pain, and are agreed with 
Dr. Churchill, that the cause of suffering is, first, the for- 
cible distension of the neck, next the pressure of the 
fibres during contraction upon the nervous filaments, and 
lastly, the dilatation of the passages. Madam Boivin, who 
speaks from what she has experienced in her own person, 
advocates this idea, and thinks that the contractions of the 
womb are not more painful than those of the bladder and 
other muscular organs. It should be remarked that the 
amount of suffering much depends upon the habits of life ; 
among savages it is slight, but it is excessive in civilized 
life. 

The dilatation of the passages. The process of dilata- 
tion, which depends upon the contractions of the uterus, 
is slow at the commencement of labor, but is effected with 
rapidity towards its close ; it has been remarked that more 
time is required to enlarge the mouth of the uterus to the 
size of a crown piece, than to completely dilate it, — when 
its diameter is about three inches. The real cause of it, 
as we have intimated, is the contraction of the uterus : by 
this the foetus is pushed against the orifice which acts like 
a wedge, and the membranes containing the liquor amnii, 
known as the bag of waters, are protruded into the upper 
part of the vagina ; when the waters are discharged, the 
child takes its place, and assists, also, in completing, suf- 
ficiently for its passage, the dilatation. 

This constitutes the first stage of labor, the length of 
which, depends upon the amount of resistance to be over- 
come ; it is greatest with first children, and in women of 
advanced age ; the mean time may be stated at from three 
to four hours. 

Discharge of glairy mucus. This term is given to a 
clear, yellowish, white colored matter, which escapes from 
the vagina during labor ; it sometimes resembles the white 
of eggs ; it escapes in small masses during the contrac- 
tions, and sometimes appears several days before labor 
commences. The quantity discharged is sometimes very 
small, and at others, very large ; when it is wholly want- 
ing, the labor is said to be a dry one ; when red streaks 



THE PAINS OF CHILDBIRTH OBVIATED. 355 

are observed in it, it is called by the women a show. This 
glairy matter is secreted by the mucous membrane of the 
vagina, and its use is to lubricate the surfaces over which 
the child is to pass. 

The bag of waters. This name has been given to the 
protrusion of the membranes of the foetus, containing the 
liquor amnii, into the upper part of the vagina, during 
labor. It is round, ovoid or globular, its shape varying 
according to the opening through which it escapes. Dur- 
ing a contraction, the bag is tense and elastic ; after this is 
over, it becomes wrinkled, or is found to have disappear- 
ed. It is formed by the contractions of the uterus, and 
its use, as has been seen, is to dilate the mouth of the ute- 
rus, without injury of the parts. It generally breaks and 
discharges its contents, near the close of the first, or at the 
commencement of the second stage of labor ; but it some- 
times happens that it is ruptured before the commence- 
ment of labor, and at others, that it is not ruptured at all. 
When its rupture is delayed till it nearly reaches the 
vulva, and it does not break in the centre, the head of the 
child carries away a portion of it, and is born covered 
with what is called a caul. It was anciently predicted 
that a child born in this way would be lucky if the caul 
happened to be of a certain color ; talismanic powers, 
have, also, been absurdly attributed to it. 



CHAPTER III. 

IS PAIN IN CHILDBIRTH A MORBID SYMPTOM ? 

Childbirth or parturition is a natural function ; and 
why the human female of civilized life suffers more dur- 
ing the performance of this function, than she does in sav- 
age life, or more than the female of the brute* creation, is 
a question of deep interest and of the greatest moment to 
our race. It is generally known that among the Indian 
tribes of our country, the women not only c?o not require 
the assistance of art in their delivery, but as labor ap- 
proaches, they re f ire alone to some secluded spot, near a 



356 THE PAINS OF CHILDBIRTH OBVIATED. 

stream of water, where nature, true to her intentions, does 
not forsake them ; after having washed the infant, and 
bathed themselves, they almost immediately return to their 
usual occupatious ; — thus presenting a spectacle very sim- 
ilar to what is observed in the inferior animals. The 
same facility in labor exists among many of the Eastern and 
African nations ; also an approach to the same is observed 
among a certain class in our own country, — those, who, 
from their necessities, exereise much in the open air, and 
live a natural life. 

Washington Irving, who travelled among the Indians, 
relates that, " a squaw belonging to the company, who 
was pregnant, one day left the company, and the next day 
overtook us on her horse, with her infant in her arms, and 
rejoined our party." Long, remarks : " One evening, I 
asked an Indian where his wife was. ' He supposed she had 
gone into the woods to set a collar for a partridge.' In 
about an hour she returned with a new-born infant in her 
arms, and coming up to me said in Chippeway, * Oway, 
Saggonash, payshik shomagonisli /' — Here, Englishman, 
is a young warrior." Other instances of this kind are 
not wanting but these are sufficient for our purpose. 
What a striking difference is here, compared to the great 
preparations and management, during a labor of a fash- 
ionable American woman ! 

"In a state of natural simplicity," says Crantz, "women in 
all climates bear their children easily and recover speedi- 
ly. The Greenlanders, mostly, do all of their common 
business just before and after delivery ; and a still-born or 
deformed child is seldom heard of. in proportion as we 
remove women from a state of simplicity to luxury and 
refinement, we find that the powers of the system become 
impaired, and the process of parturition is rendered more 
painful." 

A medical writer still further remarks : " To what else, 
but the perversion of our nature, is the origin of these 
difficulties to be ascribed ? — by deviating from her estab- 
lished laws in our habits, customs, and fashionable way 
of living — our erroneous diet, want of exercise, tight lac- 
ing, and various other fashionable vices common to civi- 
lized society: to these is woman indebted for the chief 



THE PAINS OF CHILDBIRTH OBVIATED. 357 

portion of the pains of labor, as is proved by those who 
live more agreeably to Nature's laws." 

Dr. Dewees has the following, to our subject, very ap- 
posite remarks : " With respect to the facility of labor, 
it would be wrong to suppose that the labor of the female 
brute is performed upon different principles from that of 
the human female, because she is, for the most part, 
exempt from pain ; for truly the same general process 
occurs in both, and in each the uterus exerts the same 
kind of action. The only difference is, the one is per- 
formed with pain, and the other without. Whatever 
difference, therefore, there may be in the pain of each, 
must arise from artificial causes. This would seem to be 
proved by the consequences which seem everywhere to 
follow civilization and refinement. The consequences of 
domestication may be traced in those animals which par- 
ticipate with man in his departure from his original sim- 
plicity ; for we are informed that the artificial condition 
in which the cow is placed, in our large cities, subjects 
her to more difficult and dangerous labors than those in 
the natural or less artificial state. 55 We shall here leave 
this subject, allowing the reader to decide whether the 
question at the head of this chapter is answered, and close 
the chapter with the following judicious remarks from Dr. 
Velpeau : 

Inasmuch as spontaneous parturition is a natural func- 
tion and not a disease, are we thence to conclude that the 
art of the accoucher is unnecessary, and that women in 
labor need no assistance ? Some physicians, misled by 
mistaken philanthropy, have thought so. In animals, say 
they, pregnancy brings no inconveniences, and delivery 
is almost unattended with pain. The wives of the Osti- 
acks, who are still strangers to the refinements of Euro- 
pean civilization, are delivered of their children upon the 
spot where they happen to be, and immediately resume 
their accustomed occupations, or continue their march, if 
they happen to be on a journey. I, like Roussell, have 
seen a young girl who found means to conceal from her 
parents both the humiliating proofs of her weakness and 
the operation that delivered her from it. What practi- 
tioner is there who has not had an opportunity of making 
16* 



358 THE PAINS OF CHILDBIRTH OBVIATED. 

the same observation ? The pregnancies of these poor 
creatures being illegitimate, it would seem as though they 
had no right to be sick ! 

But these remarks in no wise prove that women ought 
to be left to themselves during parturition. In the first 
place, it is false to say that parturition in animals never 
requires any assistance, and is never accompanied with 
serious accidents : sows, mares, cows, etc., are even, in 
general, quite ill, in bringing forth their young, and coun- 
try people are by no means ignorant of the fact. Does it 
follow, because some women, when compelled by imperi- 
ous motives to deliver themselves in private, or without 
taking the least precaution, escape from the serious dan- 
gers with which they supposed themselves to be threaten- 
ed, that all others may imitate them without exposure to 
more imminent perils ? If there be some whose health is 
not disturbed by such painful experiments, how many 
others are there who become the victims of their temerity ? 
Will people never be tired of referring us back to a period 
of primitive nature, that everybody talks about, and no- 
body understands ? By attempting to substitute the ex- 
ception for the rule, we inevitably fall into absurdity, and 
that is what happened to the elegant Roussell. The busi- 
ness of the accoucher, doubtless, is not to put himself in 
nature's place where a labor is natural ; but somebody 
ought to be with the woman who is able to give her proper 
directions, to forsee accidents, to recognise them, and to 
remedy them when they do take place ; to apply the re- 
sources of art when necessary, and at the opportune mo- 
ment ; who, by the confidence he inspires, calms all her 
fears, and gives courage and resignation, by tranquil izing 
her in regard to the future ; but who differs more and 
more from the mere spectator, in proportion to the extent 
of his knowledge and skill. 



CHAPTER IV. 

HYGIENE AND MANAGEMENT OF WOMEN IN CHIIJ)BIRTH. * 

It cannot be too frequently repeated, nor too strongly- 
impressed on the minds of all women and practitioners of 
midwifery, that in a natural labor, there is very little to 
do, — notwithstanding the sufferings of the patient may be 
severe : the accoucher has only to calm the woman's 
fears, endeavor to fortify her patience, regulate her diet 
and evacuations, check improper efforts, receive the child, 
tie the cord, and assist in delivering the after-birth, in the 
most cautious manner. The intelligent and prudent prac- 
titioner is well aware of the impropriety and danger of 
any interference for Me purpose of shortening or hasten- 
ing the natural process of delivery. I am fully convinc- 
ed, remarks Dr. Denman, that in the far greater part of 
really difficult labors to which I have been called — and I 
must not conceal the truth on this occasion — many of 
those which have been under my care originally, were 
not of that description from unavoidable necessity, but 
were rendered such by improper management in the com- 
mencement, or during the course of labor. It must not be 
inferred from this that women in labor never need assist- 
ance ; but it often requires great care and much knowl- 
edge to decide when nature can no longer be trusted, and 
it is necessary to call in the assistance of art. 

Hygienic management. In cities, for a lying-in cham- 
ber, a quiet, well-aired, back room should be preferred ; 
one sufficiently spacious, and with facilities for giving it a 
moderate and agreeable degree of warmth, only. Plants, 
flowers, and odors of all kinds, should be dispensed with, 
and every thing disagreeable to the woman, including all 
useless persons, should be removed from the apartment. 

Food and drinks. If a rapid delivery be expected, all 
kinds of aliment will be injurious, as the digestive powers 
are, temporarily, suspended. On the contrary, if the la- 

359 



360 MANAGEMENT OF PARTURIENT WOMEN. 

bor progress slowly, light broths or pottage may be allow- 
ed ; bat, in general, meats, bread, fruits, strong tea, coffee, 
chocolate, spirits, etc., should be prohibited : this applies 
more particularly to strong and healthy women ; some- 
times a female who is feeble but in tolerable health, may, 
• with advantage, at the commencement of labor, take a 
moderate breakfast. Most women, under such circum- 
stances, have but little desire for food, and readily per- 
ceive that they ought not to eat ; but not so with drinks ; 
on account of the excessive heat observed in most labors, 
there is a constant desire for the ingestion of fluids. Any 
simple drink may be allowed ; either water, or decoctions 
and infusions of elm, marshmallows, barley, gum, dande- 
lion, etc ; in general, all acids, wines, aromatic and heat- 
ing drinks, should be prohibited. It is only in debilitated 
constitutions, that a few spoonsful of wine may be given, 
providing there be no counter-indication from nervous ex- 
citability. * 

Excretions. The state of the foecal and urinary excre- 
tions always require attention. Constipation may act in- 
juriously not only by retarding labor, but by promoting 
the formation of hemorrhoidal tumors ; the labor may also 
be protracted by the accumulation of urine. Therefore, 
the woman should be directed, naturally, to evacuate the 
rectum and bladder while she is able to do so ; if her eft 
forts be insufficient, for the former purpose, a mild laxa- 
tive may be taken, or, what is better, an enemata of tepid 
water, or a decoction of marshmallows or flaxseed ; for 
the latter purpose, the catheter should be employed i some- 
times a male catheter answers a better purpose. 

The moral state. Parturition, remarks M. Velpeau, is 
a function that seeks the shade, that may be obstructed by 
indiscrete looks, and which as far as possible is made a 
mystery of by modest women. The accoucher ought to 
understand that the mother, the aunt, grand mother, or 
sister, are not always considered as the most agreeable 
attendants in this painful moment. As a discreet, as well 
as a circumspect and prudent interpreter, he ought to dis- 
miss without distinction, every one whose presence is not 
desired by the woman. How careful should he be him- 
self! impassible and firm, of an impurtable coolness, he 



MANAGEMENT OF PARTURIENT WOMEN. 361 

must, notwithstanding, know how to compassionate the 
distress of which he is a witness, encourage, console, 
amuse ; inspire her with boundless confidence, and great 
familiarity by the affability of his conduct, by reasoning 
that everybody can understand, by his patience, the 
amenity of his temper and the gravity of his manners ; he 
should be able to procure obedience without restraint, and 
by all the means which are suggested by moral philoso- 
phy, his own understanding and education, incessantly 
combat the discouragement and dread of all sorts, and 
sadness and alarms to which the most resolute as well as 
the most timid women sometimes give way. 

Dress, lying-in bed, etc. The dress during labor, should 
be light, and only of moderate warmth ; it should be loose 
and so arranged as not, in the least, to compress the abdo- 
men, breasts, neck, or limbs. The best lying-in bed is 
one with a tight, sacking bottom, covered with a matress. 
with bolsters, pillows, etc., so as to form an inclined 
plane. In the country, a bed is often made by tying 
together, face to face, six or eight chairs. A strong and 
well-formed woman may be delivered on any kind of a 
bed, or even on the floor, and in almost any posture. 
There are some who prefer being delivered standing, with 
the elbows resting on the mantel piece, a tabie or chair ; 
or, on their knees upon the floor. The object should be, 
to assume a position, comfortable, and one not likely to be 
interrupted. 

There can be no fixed time at which a woman should 
place herself on the lying-in bed. It is not necessary 
for her to lie down until the membranes are ruptured, 
unless it be for the purpose of rest as often as she feels 
fatigued ; she had better do so as soon as the head engages 
in the passage ; but where the pains are weak and far 
apart, even if the membranes have given way, she had 
better move about as long as her strength will permit. 
Again, should the pelvis be a very large one, and the 
mouth of the uterus be dilated without rupture of the 
membranes, or should the labor progress too rapidly, she 
should lie down early. We should remark that the woman, 
during die pains, may lie on her left side with the thighs 
drawn up, and a pillow between the knees, or on her back 



5.HJ.2 MANAGEMENT OF PARTURIENT WOMEN. • 

with the thighs half flexed, and the feet resting on the 
bed ; the former is the most common position in this 
country ; during the intervals she should be left to choose 
her own posture. 

'Touching the woman. The touch is performed at dif- 
ferent periods of labor, for the purpose of ascertaining 
whether labor has commenced, what part of the. child pre- 
sents, how far the labor has advanced, etc. Rigorously 
speaking, says Velpeau, it would be sufficient t9 touch 
three times during a labor; once at the commencement, 
to learn whether the womb is contracting ; a second time, 
just as the waters break, to make ourselves positively sure 
of the position ; and a third, when the pains and efforts 
have acquired a certain degree of strength, in order to 
see whether the parts engage properly in the excavation ; 
but, generally speaking, unless the vulva and vagina are 
irritable, we may repeat the operation more frequently. 

Touching, although it may be annoying to the woman, 
cannot, safely, be dispensed with. Almost every physi- 
cian has been, frequently, kept out of his house all night 
lor the purpose of being near a patient supposed to be in 
labor, having been refused the privilege of making an ex- 
amination ; upon its being acceded to, the mouth of the 
uterus has been found closed, and sometimes he has been 
obliged to announce that the woman had not reached her 
full term by two or three weeks. It is extremely vexa- 
tious to be thus baffled by the backwardness of the patient 
to submit to an operation that is inevitable. In perform- 
ing the operation, the finger had better be oiled and intro- 
duced during a pain ; when a remission takes place we 
should minutely examine the parts. 

The diagnosis is thus briefly stated by Churchill : The 
head may be known by its hardness, by the sutures and 
fontanelles. The breech, by its softness, by the cleft be- 
tween the buttocks, the anus, or coccyx, scrotum, or vul- 
va. The knee, by its rounded form, by the condyles ot 
the femur. The foot, by its long form, its being at right 
angles with the leg, the nearly equal length of the toes, 
the narrow heel, etc. The elbow, by the olecranon pro- 
cess rendering the joint sharper than the kne*. The hand 



MANAGEMENT OF PARTURIENT WOMEN. 333 

by its shortness, the unequal length of the fingers,and the 
divarication of the thumb. 

Conduct of the woman. The courage and will of the 
patient may exert great inflnence on the progress of labor. 
The by-standers, and sometimes the practitioner, very 
wrongly direct the patient to bear down, as soon as the 
pains become somewhat strong ; such conduct can only be 
the fruit of ignorance, for before the membranes are bro- 
ken or the os uteri dilated, such efforts only exhaust the 
woman to no purpose. But at the end of the first stage, 
or as soon as the child engages in the passage, the womb 
powerfully contracts, and there is felt a desire to bear 
down independently of the woman's will ; now that the 
general muscular power is solicited, she should bear down 
with all her might — suspending all effort, however, as soon 
as the womb ceases to act. - There are some timid women,- 
who are restrained from assisting the contractions for fear 
of making their pains too sharp ; such should know that 
nothing can save them from the pain, and that by so doing 
the period of delivery is protracted. Others there are, 
who give themselves up to immoderate efforts ; &ach 
should be informed, that they expose themselves to serious 
consequences, such as congestion of the brain, bursting of 
the large veins, hernias, etc. 

Conduct of the attendant. We are told by authors of 
accouchers, who. placing themselves between the knees 
of the woman, with the coat off and sleeves tucked up, 
forcibly dilate the passages under the pretext of accelerat- 
ing the labor ! ; and that sometimes females themselves, 
not knowing the dangers to which they are thereby ex- 
posed, are the first to ask for it ! This can never be done 
with safety ; and the poor creatures who submit to such 
procedures, run the risk of having a natural labor con- 
verted into a complex one, which may prove fatal not only 
to the child, but to the mother. Sometimes, when there 
is much rigidity and irritability of the parts, it may be 
useful to introduce one or more fingers for the purpose of 
applying some mucilage or belladonna ointment ; but 
further than this, interference is not permissible. 

When the efforts are violent, and just as the head 
reaches the vulva, it has been recommended to support 



«>>4 MANAGEMENT OF PARTURIENT WOME.X. 

the perineum by pressing against it with the hand or fin- 
gers, for the purpose of preventing laceration ; but this is 
not necessary, unless the contractions be extremely vio- 
lent, — and even then it may prove an evil instead of a 
benefit, unless care be? taken not to prevent the descent of 
the child. 

Receiving the child. As the head passes through the 
vulva, it should be received into the right hand, allowing 
it to make the usual rotation, and carrying it forward as 
the pains expel the shoulders and body of the child ; the 
left hand should be employed in clearing its mouth of any 
mucus or membrane that may be there, and before the 
shoulders are expelled, in feeling to ascertain whether 
there be any coil of the cord around the child's neck, as 
occasionally happens to the imminent risk of its life. 
When the child is born it may-be laid on one side with its 
back to the mother. 

Separating the child, If the child be in good condition, 
it will cry very soon after being born ; when respiration 
is established, it should be brought into view, and after 
tying the cord, separated from the mother, rolled in flan- 
nel, and given to the nurse. The ligature, which should 
have been previously prepared, may consist of a piece of 
fine tape, or several pieces of thread, which, after waiting 
until pulsation in the cord has ceased, should* be placed 
around it at about one inch from the navel : the cord is 
then to be cut by the scissors. Some authors recommend 
the application of a second ligature about an inch from 
the first, and the cutting of the cord between them ; and 
this becomes always necessary when there are twins. Be- 
fore the child is dressed, the end of the cord should be ex- 
amined, and if any oozing of blood be observed, another 
ligature should be applied nearer the navel ; this frag- 
ment of the cord withers, and generally falls off in five or 
six days. l 

The hand should now be placed over the womb, for the 
purpose of ascertaining (from the size of the uterus) 
whether there are twins ; if not, the binder may be appli- 
ed, which should extend from the chest, embracing the 
whole abdomen and hips ; if another or other children be 



MANAGEMENT OF THE CHILI*. 365 

found, their delivery must be proceeded with in the same 
manner as the first. 

Delivery of the afterbirth. After the uterus contracts 
and detaches the placenta, (which it generally does within 
ten or twenty minutes after the expulsion of the child) it 
is commonly very soon expelled into the vagina ; this may 
be ascertained by making gentle traction on the cord, 
when it will come away. But if it be not yet detached, 
no force should be used ; all that is required, is patience, 
. with occasional frictions by the hand over the uterus. 
After the placenta has been delivered, the binder, if ne- 
cessary, may be tightened, the soiled sheets and clothing 
should be removed, and the vulva and other soiled parts, 
cleansed, without any exertion on the part of the woman. 
Stimulants and sedatives should be dispensed with, unless 
there be some particular indication ; in general, rest and 
quiet are the best and only necessary restoratives. The 
pulse and uterine tumor may be examined from time to 
time in order to see whether all is right. 

Management of the child. The child at birth is found 
covered with an unctuous matter, which adheres closely 
to the skin ; this is more easily washed off with a weak 
solution of soap and water, or wiped off by a napkin, af- 
ter being diluted with a little olive oil, mucilage, or grease 
of any kind. Some persons recommend that the child be 
plunged into a cold bath ; but such conduct, to say the 
least, is extremely questionable and dangerous in a being 
so frail as that of a new-born infant : the same may be 
said of alcoholic or strengthening baths. There is, how- 
ever, no objection to a tepid or moderately warm bath of 
water simply. 

After wiping the child dry, the bandage or binder for 
the support of the navel, is next to be applied. A light 
compress, with a hole in the centre, should be placed over 
the navel, with the end of the coru put through the open- 
ing ; over this and around the abdomen, a bandage should 
be passed, long enough to go once and a half round. This 
band, if too tight, would do harm ; on the contrary, if too 
loose, it would slip off and do no good. It may be con- 
tinued a week or two, and even a few months, if the na- 
vel project too much. The dress of the child, whatever 
17 



3G6 MANAGEMENT OF THE CHILD. 

the style may be, should be loose, and not too warm or 
cumbersome. It does not need " molasses and water," or 
any thing else, to expel the meconium, excepting the 
mother's milk ; the child should be put to the breast ill a 
few hours. 

When the child does not breathe. The child may be 
born in a state of defective vitality, syncope, or apoplexy. 
The former conditions may be produced by uterine he- 
morrhage, too early detachment of the placenta, or defect- 
ive nutrition : there is very little pulsation in the cord, • 
only feeble efforts at inspiration, and but little action of 
the heart. In such cases, we should defer the division of 
the cord, apply warm flannel and rapid frictions, with or 
without stimulants, to the body and extremeties. Or, a 
warm bath may be tried, sprinkling with cold water, tick- 
ling the nose or fauces with a feather, electricity, and 
slightly stimulating enemata ; and lastly, inflation may be 
tried by a proper tube introduced into the larynx, or pass- 
ed through the nose. 

Apoplexy of the child may be caused by prolonged la- 
bor, pressure from a narrow pelvis, etc. In such cases, 
the surface is blue, the face livid, action of the heart la- 
bored, with but feeble pulsation in the cord. The treat- 
ment consists in relieving the circulation by dividing the 
cord, allowing from a half to an ounce of blood to escape 
before tying it. If this does not succeed, cold sprinkling, 
warm baths, friction or inflation may be tried. Our ef- 
forts, in such cases, should be continued for a considera- 
ble length of time. 

Tumors of the scalp of the child, which we should ad- 
vert to, most often subside without treatment : they are 
caused by pressure during labor, and consist of the effu- 
sion of serum and blood under the scalp. When they 
persist several days, spirits or stimulating lotions may be 
used, and if unsuccessful, the tumor should be punctured, 
and simple dressings applied. 

Bleeding of the cord from incomplete closure of its ves- 
sels after the falling off of its remains, is difficult to ar- 
rest, but fortunately, is not of frequent occurrence. The' 
navel should be filled with alum, or some other astringent, 
and retained by a compress and bandage. Dr. Churchill 



MANAGEMENT OF DIFFICULT LABOR. 267 

suggests that the naval should be stretched open, and fill- 
ed with plaster of Paris, either dry or moistened, which 
would probably become solid in spite of the hemorrhage. 



CHAPTER V. 

MANAGEMENT OF DIFFICULT LABOR. 

Br difficult or tedious labor, is indicated those cases 
which terminate without manual or instrumental assist- 
ance, but are prolonged beyond the usual time, and are 
attended with unusual suffering. The danger of a pro- 
longed labor depends upon the stage in which the delay 
occurs : thus, delay in the first stage, involves little or no 
danger, either to the mother or child, notwithstanding it 
may continue for several days ; while delay in the se- 
cond stage, which must be vastly shorter, is of more seri- 
ous consequence. The continued suffering may produce 
a great degree of fatigue and depression of spirits, and 
the patient often expresses a great dread of the result and 
importunes for assistance ; but the strength is seldom 
much impaired, and the condition of the patient is not un- 
favorable : — the nervous shock not being severe in the first 
stage. The most common cause of delay, is inefficient 
action of the uterus, and occurs mostly in delicate, feeble 
women, those of lymphatic temperament, and who are 
confined for the first time ; it may also arise from a de- 
rangement of the digestive organs, mental depression, ple- 
thora, etc. 

In the treatment of these cases, nature needs very little 
or no assistance ; time and patience are the principal reme- 
dies. The patient should be encouraged, cheered and 
amused : all depressing circumstances must be kept from 
her ; she should keep up and walk about during trie day 
as much as possible, resting occasionally on a sofa. The 
bowels, if necessary, must be freed by a dose of castor 
oil, or enemata, and the diet should be nourishing but 
bland. When there is much plethora, blood may be 
abstracted with advantage. After this, if there ba much 



368 MANAGEMENT OF DIFFICULT LABOR. 

irritability and exhaustion, opium may be given for the 
purpose of procuring sleep. Such means are very often 
successful in inducing uterine contraction. 

After all obstructions, in this manner, are removed, and 
the action of the uterus is not vigorous enough, almost all 
accouchers agree in regard to the propriety of adminis- 
tering the ergot of rye, providing no counter indication 
exist. The circumstances under which it may be given 
are the following : 1, if the mouth of the uterus be soft 
and dilatable ; 2, if there be no obstacle to a natural de- 
livery ; 3, if there be no head symptoms, nor excessive 
irritability. On the other hand it should be prohibited : 
1, if the mouth of the uterus be hard and rigid ; 2, if 
the pelvis be deformed, or if there be any serious obstacle 
to delivery in the soft parts ; 3, if there be head symptoms, 
or much irritability. 

The powder of the ergot is generally preferred, and may 
be; given in fifteen or twenty grain doses ; half a drachm 
to a drachm of the tincture, or from five to ten grains of 
the extract ; any one of which may be given with an in- 
terval of twenty minutes, until three doses shall have been 
administered, unless the effect be produced sooner. > If it 
succeed, the pains are found to grow stronger soon after 
its exhibition. We should remark, that it ought not to be 
resorted to on slight occasions, and that, although it may 
often anticipate the use of the forceps, it sometimes pro- 
duces disagreeable consequences. Stimulating purgative 
enemata, and stimulating frictions externally, are also, 
often very beneficial in assisting uterine contraction. 

Rigidity of the passages. Labor sometimes becomes 
difficult, particularly in women with the first child, and 
those of advanced age, in consequence of a rigid state of 
the mouth of the uterus, and of the soft parts. There are 
very few cases, if left alone, that would not overcome 
these obstacles, though at the expense of considerable 
fatigue, and in a few cases of slight laceration of the neck. 
The most effectual remedy for rigidity is venesection ; but 
it can be often obviated without resorting to this : by warm 
mucilaginous injections ; warm hip-baths ; and lastly by 
nauseating the patient with tartar emetic, which rarely 






MANAGEMENT OF DIFFICULT LABOR. 389 

fails. Patience, here also, is one of the most important 
means. 

Toughness and weakness of the membranes. The mem- 
branes generally give way as soon as the mouth of the 
uterus is fully dilated ; but they sometimes, from abnor- 
mal firmness, remain entire, thus causing delay. On the 
other hand, they may be ruptured at too early a period ; 
this may occur from weakness of the membranes, from 
violence, careless examinations, etc. In the former case, 
the membranes may be ruptured : but the delay should 
not be attributed to this cause on slight grounds. In the 
latter, all that is necessary is time and patience. 

Obliquity of the uterus. This may occur during preg- 
nancy from the position in which the patient lies, either 
one way or the other; and the relaxation of the walls o*f 
the abdomen may cause " pendulous belly." These cases 
sometimes occasion delay and may be remedied by placing 
the patient on her back, or in other positions according to 
circumstances ; also, when it becomes necessary, by raising 
up and supporting the tumor of the abdomen by a bandage. 

Retained placenta. If the afterbirth be retained beyond 
from four to six hours, notwithstanding the use of those 
means directed in the preceding chapter,, its delivery re- 
quires assistance. It may be retained for want of uterine 
contraction, or on account of a firmer adhesion than usual 
to the uterus. In the former case gentle traction on the 
cord, frictions to the abdomen, and exhibition of the ergot 
rarely fail ; in the latter, it sometimes becomes necessary 
to cautiously introduce the hand (previously oiled ) w tne 
form of a cone, and gently detach the placenta by ^raau- 
ally pealing it off, acting from the edge towards the cen- 
tre: the hand should then be allowed to be expelled 
along with the afterbirth by the contractions of the uterus. 

Hemorrhage or flooding, complicated with, or after de- 
livery, requires to be treated essentially in the same man- 
ner as directed in the chapters on Abortion and Menorrha- 
gia. In the former case the patient must be kept perfect- 
ly at rest, the vagina plugged, cold applied, and opiates 
with astringents given internally: when the proper period 
arrives, the labor should be terminated as soon as practi- 
cable ; either by the use of the ergot or instruments, ac- 
ta, 



370 MANAGEMENT OF .DIFFICULT LABOR. 

cording to circumstances : the latter is rarely necessary. 
When flooding occurs after delivery, the placenta should 
be extracted as soon as possible : the ergot is here useful 
in two ways : by bringing on contraction, and arresting 
the bleeding ; in addition, all those means above mention- 
ed should be resorted to for arresting the hemorrhage. 

Labor, complicated with convulsions, is to be treated as 
directed in Chapter V. Section II. Book II. 

There are certain classes of labor, (happily of rare oc- 
currence) of which it does not come within our purpose to 
speak in this work : such as powerless, obstructed or com- 
plicated, and instrumental labors. These arise from dif- 
ferent causes, the principal of which are the following : 
great debility of constitution ; tumors, and other diseases 
of. the uterus and pelvis ; narrowness of the vagina and 
os uteri ; deformed pelvis ; ovarian tumors, etc. 

Obstetric operations may be divided into three kinds : 
1, those which . are not intended to injure the mother or 
child, as induction of premature labor, version or turning, 
the use of the vectis and forceps; 2, those which involve 
the destruction of the child, but which are not intended to 
injure the mother, as craniotomy ; and 3, those in which 
danger is involved, both to the mother and child, as the 
Caesarian section. 

The use of instruments and manual operations are not 
unattended with danger : neither should be resorted to, 
and particularly the former, except in aid of nature, or 
unless the life of the mother or child can be saved by their 
employment. 



SECTION n. 
DISEASES OF CHILDBIRTH. 



CHAPTER I. 

CONDITION OF THE PATIENT AFTER DELIVERY MANAGEMENT 

OF WOMEN IN CHILDBIRTH, WITH VARIATIONS FROM ORDI- 
NARY CONVALESCENCE. 

Upon examination of a woman a few hours after deli- 
very, we observe considerable change both locally and 
generally. The nervous system is found to have received 
a shock more or less severe, there is disturbance of the 
respiratory and circulating systems, the secretions are al- 
tered, and there is great exhaustion. When these effects 
are moderate, they gradually subside, providing the pa- 
tient be kept from all disturbance and excitement, and ob- 
tain a few hours sleep. 

The uterus, after delivery, contracts more or less firm- 
ly : this is beneficial in emptying the uterine cavity, di- 
minishing the mouths of the uterine vessels, and prevent- 
ing hemorrhage. The same as during labor, so following 
it, after a short period of contraction, there is an interval 
of relaxation ; this, gradually, reduces the size of the 
uterus, and about the eighth or tenth day, it becomes 
small enough to descend into the pelvis. The mouth of 
the uterus, after remaining open for some days, gradually 
closes. The vagina, which was enormously distended, 
and more or less inflamed and sore, shortly becomes re- 
duced in size, and the outlet resumes its natural capacity 
in a shorter time than would have been supposed possible. 
The integuments of the abdomen, remain flaccid and loose 
for a considerable length of time ; but if it be properly 

371 



372 MANAGEMENT OF WOMEN IN CHILDBED. 

bandaged, neither too tight nor too loose, they return to 
their natural condition in the course of a month or two. 
Women in a first confinement, do not often suffer from 
after pains ; but in subsequent labors, the contractions of 
the uterus above noticed are accompanied by pains more 
or less severe : they generally come on in about half an 
hour after delivery, and may continue thirty or forty hours, 
or longer. 

The discharge of blood which accompanies labor, con- 
tinues for some time after : soon, its character changes, 
when it is known as the lochia, or in popular language the 
" show" or " cleansings." This watery discharge con- 
tinues of a red color for three or four days, when it be- 
comes greenish or yellowish, and generally ceases in three 
or four weeks ; though sometimes it ceases within a few 
days after, delivery. The breasts, generally, begin to en- 
large about twenty-four hours after delivery, which is ac- 
companied by stinging pains : at about the end of the 
second day, they become large, tense, and sore. The se- 
cretion of milk now takes place, which soon becomes 
abundant ; that which is first secreted, often acts as a pur- 
gative upon the child. Frequently, though seldom with 
first children, milk is secreted during labor, and the 
woman can give suck immediately afterwards. 

Management of the woman* After having given a de- 
scription of the condition of the female, we shall now re- 
cur to her management. The room in which the woman 
is put to bed should be slightly darkened ; she should be 
kept perfectly quiet, very few persons should be allowed 
with her except the nurse, little talking should be allowed, 
and no whispering. The horizontal posture must be pre- 
served, all mental emotion and excitement avoided, and 
the patient be kept calm and cheerful, and allowed to 
sleep. The state of the pulse should be narrowly watch- 
ed, as it is often the first evidence of wrong. 

Very soon after the conclusion of labor, (after having 
cleansed the parts with tepid milk and water, containing a 
small portion of spirit,) a warm napkin should be applied 
to the vulva, which should be changed at short intervals. 

The washing, for the sake of cleanliness and to aid in 
restoring the parts, should be repeated twice a day. The 



MANAGEMENT OF WOMEN IN CHILDBED. 373 

after-pains require no treatment, unless the patient be de- 
prived of sleep, when an aromatic purgative, or a dose of 
laudanum may be given. The only attention which the 
lochia requires, is, that the napkins should be changed 
sufficiently often, and applied warm, as the impression of 
cold might be followed by its suppression. 

The patient, who is generally in a state of perspiration, 
should be allowed to cool gradually ; the bed-clothes should 
be light but comfortable, the room kept cool and fresh. 
Let it be remembered that the female cannot assume the 
upright posture without the risk of hemorrhage and dis- 
placement of the womb ; so it should, on no account, be 
permitted. 

The patient should be reminded to void the urine within 
six or eight hours after delivery, or sooner ; if she be not 
able to do this, after having applied a cloth wrung out of 
warm water, the catheter must be used. It is quite as 
well that the bowels remain unmoved for twelve or fifteen 
hours after delivery ; after this, if necessary, a discharge 
should be procured by a dose of castor oil, senna and salts, 
or rhubarb. 

When the breasts become tense and painful, the best 
remedy is the application of the child ; the sooner this is 
done the better, as the secretion and escape of milk will 
be facilitated, and engorgement, perhaps inflammation, of 
the breasts avoided. Relief may, also, often be obtained 
by friction with warm oil, or emollient fomentations, and 
at the same time giving an aperient dose. They should 
not be kept excessively warm, and all compression and 
astringent applications with a view of preventing the com- 
ing of the milk, are dangerous in the highest degree. 

The diet, during convalescence, is of great importance. 
The patient, for the first four or five days, should be con- 
fined to bland articles — gruel, whey, arrow-root, panada, 
milk, etc., with a little toast or biscuit. After the milk 
fever has subsided, she may take, providing there be no 
counter-indication, some broth, and on the eighth or ninth 
day, some fowl or fish. 

All that concerns the diet, and the assumption of the 
upright position, or making exertion, is of the utmost im- 
portance. The patient should not leave her bed : even to 



374 VARIATIONS FROM ORDINARY CONVALESCENCE. 

have it made, before the fourth day ; and she should make 
very little or no exertion for the space of eight or nine 
days : in some cases, fifteen and even twenty days' con- 
finement, is indispensable. Most of the diseases which 
affect a woman in child-bed, remarks Velpeau, may be at- 
tributed to the thousands of visits of friends, neighbors, or 
acquaintances, or the ceremony with which she is too of- 
ten oppressed : she wishes to keep up the conversation ; 
her mind becomes excited, the fruit of which is headache 
and agitation ; the slightest indiscreet word worries her ; 
the slightest motives of joy agitate her in the extreme ; 
the least opposition instantly makes her uneasy, and I can 
affirm that among the numerous cases of peritonitis met 
with at the Hospital de Perfect ionnement, there are very 
few whose origin is unconnected with some moral com- 
motion. 

VARIATIONS FROM ORDINARY CONVALESCENCE. 

1. The nervous shock is sometimes severe, which is 
known by the great exhaustion, hurried breathing, dulness 
of the senses, and anxious and suffering expression of the 
countenance. Reaction is long in taking place, or it may 
take place imperfectly or excessively. The best remedy 
in these cases is opium, given in a large dose, or in small 
and frequently repeated ones ; stimulants, also, in moder- 
ate quantities, will be very useful ; as ammonia, musk, 
or, wine or brandy and water, which should be discontin- 
ued when reaction takes place; the diet should be nutri- 
tious, but bland. 

2. The state of the pulse should be attentively estimat- 
ed, which requires great care, as it indicates the general 
condition of the patient : it will be quickened when a large 
coagulum is contained in the uterus, when there is distur- 
bance of the bowels, and when inflammation exists. Soon 
after delivery, the pulse falls, but becomes more frequent 
when reaction takes place : . if it exceed one hundred, no 
time should be lost in ascertaining the difficulty. 

3. The uterus, instead of gradually decreasing in size, 
occasionally, at the fifth or sixth day, becomes less firm 
and increased in bulk, which threatens an attack of in 



VARIATIONS FROM ORDINARY CONVALESCENCE. 375 

flammation. Under such circumstances, hot fomentations 
should be applied to the abdomen, and a warm purgative 
given, which will favor the expulsion of clots, if any 
there be, and diminish the tenderness. The vagina may 
be attacked with inflammation more or less severe, when 
it requires about the same treatment; extreme cleanliness 
should be observed, and vaginal injections of warm water 
may be tried. 

4. The after-pains. Instead of the after-pains coming 
on half an hour or an hour after delivery, being moderate, 
and ceasing after a short time, they occasionally com- 
mence with great severity as soon as the labor is termi- 
nated, and are of long continuance. The best remedy, is 
the application of hot flannels, emollient fomentations, and 
a full dose of opium, to be repeated if necessary. They 
sometimes continue at intervals unusually long, and are 
increased by applying the child to the breast : relief may 
be obtained by enemata, aromatic purgatives and opium. 

5. The lochia. Although variations in the quantity 
and quality of this discharge generally excite the alarm 
of the patient, yet, great differences often occur, without 
any evil result. The discharge sometimes ceases a few 
hours after delivery, particularly after the , birth of imper- 
fectly developed and still-born children ; on the contrary, 
it may continue unusually long; or, again, be excessive, 
or diminished, and continue the. usual time. A sudden 
suppression of the lochia may take place from violent and 
sudden impressions or emotions, cold, and the use of 
astringent injections, which commonly gives rise to serious 
affections ; such as inflammation of the uterus or perito- 
neum, and nervous disorders. 

The treatment of sudden, suppression of the lochia, 
consists in the employment of a hot foot-bath with mustard, 
the application of hot fomentations and emollient poultices 
to the lower part of the abdomen and vulva, and injec- 
tions and enemata of the same sort. Blood-letting, when 
indicated by the state of the pulse, or where plethora ex- 
ists, the application of leeches to the thighs and labia, 
cupping the loins, arid sinapisms to the feet and limbs are 
valuable remedies. In nervous women, antispasmodics 



376 VARIATIONS FROM ORDINARY CONVALESCENCE. 

must be used ; in those of feeble constitutions, stimulants 
are necessary. 

When the lochia is excessive, or continues beyond the 
usual time, tonics, as bark, iron, etc., should be allowed, 
with a better diet. When it ends in the establishment of 
leucorrhea, it should be treated as directed in that chap- 
ter. If it become acrid, and excoriate the external parts, 
strict cleanliness must be observed, with the use of astrin- 
gent lotions and vaginal injections of warm water. Lastly, 
W this discharge become offensive, as it sometimes does 
from the decomposition of a small portion of the afterbirth, 
it should be treated by injections. of warm water or a very 
weak solution of chloride of lime. 

6. The milk fever. -The variations of the period at which 
the milk is secreted are of little or no consequence. If 
the fever be excessive, it must be moderated by emollient 
fomentations, purgatives, and the frequent application of 
the infant to the breasts. In some rare cases no secretion 
of milk takes place, then the child will require a wet 
nurse. When the nipples are imperfect, they should be 
drawn by an adult, or the breast pump ; if these do not 
succeed, the effects of the secretion of milk must be ob- 
viated by tartar emetic, saline purgatives, and fomenta- 
tions. 

Laceration of the perineum, when they occur, generally 
get well of themselves ; all motion should be avoided, 
and the woman kept mostly on her side so as to favor the 
discharge of the lochia and pus. A longer confinement 
than ordinary must be observed, and sometimes it becomes 
necessary to apply caustic, take up certain points with the 
needle, etc., which belong more properly to surgery. 
The same may be said of lacerations of the vagina, {con- 
stituting vesicovaginal fistula) of the neck, body, and fun- 
dus of the womb, which are of extremely rare occurrence. 

Infiltration of the external genitals, from injuries in 
the passage of the child, may be so extensive as to pre 
vent the discharge of the lochia. If the swelling be lym- 
phatic and not painful, it will generally disappear upon 
making a few punctures. When there are signs of in- 
flammation, resource should be had to emollient poultices 
fomentations, and if necessary to leeches. 



PUERPERAL FEVER. 377 

There are other accidents and diseases incident to the 
lying-in ; invasion and prolapse of the womb and vagina, 
ant i- version and re-troversion of the uterus, inflammation, 
etc., of the vagina and womb — all of which we have 
treated of in Book I. The other diseases of parturition 
are, puerperal peritonitis, uterine and crural phlebitis, me- 
tritis, phlegmasia dolens, cutaneous eruptions, injlamma* 
tion of the breasts, etc., which we shall now proceed to 
treat of. 



CHAPTER II. 

PUERPERAL FEVER, INCLUDING PERITONITIS, UTERINE AND 
CRURAL PHLEBITIS— CAUSES SYMPTOMS AND TREATMENT. 

Puerperal fever is not of rare occurrence, and is, 
perhaps, the most fatal disease to which lying-in women 
are exposed. It is more frequently accompanied with in- 
flammation of the peritoneum, though it may commence 
from inflammation of the uterus and its appendages, of the 
veins and absorbents of the uterus, and ,of the crural 
veins ; in either case, if the inflammation continue a suffi- 
cient length of time, the peritoneum generally becomes 
implicated, and a train of symptoms arises, very similar 
in character, which, by the common consent of authors, is 
called puerperal fever. This disease may commence a 
few hours after delivery, but rarely occurs after the first 
two or three days. It may be accidental and sporadic ; 
or it may prevail as an epidemic, when it is a most dread- 
ful and deadlv affection, seeming to be contagious. 

Although differences of opinion still exist in regard to 
the contagious quality of certain forms of this disease, it 
is well known that the epidemic form may arise in the 
way of contagion : this horrible malady, remarks Dr. 
Watson, may be communicated from one lying-in woman 
'© another by the intervention of a third person ; and 
loubtless it is so carried and propagated, in many instan- 
.v>s by midwives and accouchers. 

Causes. — The sporadic form of this disease is supposed 

Q* 



878 PUERPERAL FEVERS-CAUSES — SYMPTOMS. 

to arise from difficult labors ; from clots, or fragments of 
the placenta retained in the uterus ; suppression of the 
lochia ; arrest of the secretion of the milk ; constipation ; 
diarrhoea; violent mental emotions; stimulants; cold; 
binding the abdomen too tight ; violence during labor ; 
exertion too soon after labor, and from an attack of ery- 
sipelas. 

The epidemic form of puerperal fever is produced by 
contagion, or by a distempered state of the atmosphere. In 
1831, a physician of London, examined the body of a 
woman who died a few days after delivery, from peritoni- 
tis; the next morning he safely delivered a woman, who, 
two days afterwards, was attacked with severe rigors, 
acute pain of the abdomen, a rapid, feeble pulse ; she 
died four days from the period of attack. The same phy- 
sician, soon afterwards, attended two other patients, both of 
whom fell victims to the same disease; he also bled a 
young woman for pleurisy : an erysipelatous inflammation 
extended from the wound up the arm, and the patient 
died in four or five days of phlebitis. Similar cases to 
the foregoing have not been uncommon either in this 
country or Europe ; it has repeatedly prevailed as an epi- 
demic in lying-in hospitals, when most of those attacked 
!\a.M! died ; in private practice, it is less fatal. A physi- 
cian of Philadelphia, extensively engaged in obstetrical 
pmciH e, lost almost every patient that he attended for 
Cftpcrnl weeks ; he left the city, exchanged every article 
df It I;? wearing apparel, and, after appropriate ablutions, 
pw! remaining away a week, returned; but to his great 
^rJC*tf;ernatbn, the first case he attended, terminated fatal- 
.Ij? from an attack of puerperal fever ! He was now sat- 
M'rvi lhat the disease, in his. case, was not transmitted by 
ji-vi Corson or clothes, but was propagated by atmospheric 
f>iJ(nenoe. Other physicians, under similar circumstances, 
hrn'e hern successful in divesting themselves of the poi- 
«?ir> i-v such »i rings and purifications, and no more cases 
bfcW3 occurred in their practice. 

Hyp.TiTOMs. — The attack generally commences within 
iVty-eight hours after delivery ; there are, however, some 
exceptions: its occurrence may be delayed some days, or 
it mpv, in rare cases, commence before labor. There is, 



PUERPERAL FEVER TREATMENT. 379 

usually, a rigor, or shivering fit, succeeded by hot fever, 
terminating in perspiration, with a rapid pulse, tenderness 
upon pressure, and pain low in the abdomen ; soon, a uni- 
versal swelling takes place, and the womb can no longer 
be felt. The lochial discharge is most often .arrested ; 
but sometimes it is undisturbed. The urine, which is 
voided in small quantities at a time, and with pain, is tur- 
bid ; there is usually tenesmus, vomiting of green or yel- 
low, bitter matter, which at last becomes black.. The 
brain and nervous system is, sometimes, involved, produc- 
ing delirium and stupor; finally, there is extreme pros- 
tration, ulceration of the mouth and throat, and the dis- 
ease may terminate in resolution, which is the most 
favorable ; in suppuration, when fluctuation of the matter 
is usually perceptible ; and lastly, in mortification, which 
is accompanied by a treacherous calm, in lh<\ midst of 
which, the patient expires. * 

We should remark, that puerperal fever may arise ana 
progress without being attended by any acute symptoms. 
The disease usually runs its course in three or four days ; 
it may, however, be protracted, from five to ten or twelve 
days. The epidemic is the more malignant form — one- 
half, two-thirds, and even more, of those attacked, dying; 
the accidental or sporadic form, is much less fatal. 

Treatment. — Of all acute diseases, remarks Dr. Gor- 
don, the plague excepted, the puerperal fever is, perhaps,, 
the most dangerous. But this can only be true in refer- 
ence to the most malignant form, for, generally, not more 
than one case in ten has proved fatal ; and some physi- 
cians have attended many cases, during a long practice, 
without losing a single patient. The majority of writers 
recommend copious bleedings and it cannot be denied that 
this is the appropriate treatment' for most cases ; yet, there 
are some cases, characterized by an absence of acute 
symptoms, that do not well bear this. 

When the pulse is quick and firm, there is no time to 
be lost ; blood-letting, from the arm. is the proper remedy. 
Dr. Gordon recommends, at the beginning, the abstraction 
of from twenty to twenty-four ounces, to be repeated if 
necessary; but the quantity taken must depend, in all 
cases, on the condition of the patient. Also a large num. 



380 PUERPERAL FEVER — TREATMENT. 

ber of leeches to the abdomen — fifty or more, may be ap- 
plied, according to circumstances, and followed by fomen- 
tations, or a large, light, bran poultice. The next anti- 
phlogistic of considerable power, is calomel, in combina- 
tion with ipecac and opium, which may be given in large 
doses, or smaller ones, frequently repeated : when the 
bowels are affected, the opium should be continued alene ; 
this remedy may be used after bleeding, or instead of it, 
where, the abstraction of blood is inadmissible. If the 
bowels be constipated, an enema of turpentine and cas- 
tor oil should be given ; or, they may be given by the 
stomach, combined, if necessary, with Dover's powder. 
When the diarrhoea i's copious, it may be restrained by 
opiates and astringents. 

The use of emetics has been recommended, and may be 
useful in the earliest stages of the disease. Blisters to 
the abdomen are useful as soon as the acute stage is pass- 
ed. Mercurial ointment may be used externally to the 
abdomen at the same time that calomel is given internally ; 
sinapisms to the feet should also be tried. Some physi- 
cians have met with great success in the use of copious 
purging — with the oil of turpentine, calomel and jalap, 
etc. Nitre, ipecac, Dover's powder and opium, should 
be used as diaphoretics, and to assuage pain. Finally, as 
soon as the inflammatory symptoms subside, the patient 
must be supported by the use of wine and porter, bitter 
infusions, quinine, and a nourishing but bland diet. 

From our remarks upon the contagious character of 
puerperal fever, the necessity will be seen for every pos- 
sible precaution, particularly in the epidemic form, by ab- 
lutions, change of dress, fumegations, ventilation, white- 
washing and painting ihe rooms, etc. 



CHAPTER U:. ■ 

PHLEGMASIA DOLENS OR MILK-LEtf CArfSteS -StM?TG*!S, 

AND TREATMENT. 

This disease consists in a swelling of one or both le^tf 
a few days after delivery, accompanied with pain and ten- 
derness. It rarely involves both limbs at once, and it is 
said that the left leg is more frequently affected than the 
right. This affection was called milk-leg from its having 
been formerly supposed to be caused by a metastasis and 
deposit of milk ; but it is now believed to depend on ob- 
struction of. the venous circulation of the lower extreme- 
ties, which arises from difficult labor, the impression of 
cold, and uterine irritation. 

It most commonly commences in the calf of the leg, 
though sometimes it begins in the pelvis ; in either case, 
there is generally a chill, followed by intense fever and 
pain, which gradually affects the whole limb : sometimes, 
however, it is confined to a part of it. The limb soon be 
comes enlarged, and sometimes reaches an enormous size. 
The affection ordinarily lasts from four to six weeks, when 
the limb gradually becomes smaller ; but it sometimes 
ends in suppuration and death : the part affected most of- 
ten remains somewhat enlarged through life. The con- 
stitution suffers considerably during the attack : there is 
thirst, a quick pulse, loss^of appetite, derangement of the 
bowels, and general restlessness. 

Treatment. — In the acute stage, antiphlogistics are in- 
dicated : the application of leeches in the vicinity of the 
pain, to be followed by poultices, saline purging, bleed- 
. ing, if there be much plethora, cooling drinks, and Do- 
ver's powder, to relieve the pain. When the acute symp- 
toms subside, the limb should be gently supported by a 
flannel bandage, and a slightly stimulating linament may 
be employed : blisters, also, have been highly recommend- 
17* 381 



382 SORE NIPPLES SCANTY SECRETION OF. MILK. 

ed. Tonics will be required internally, as bark and qui. 
nine, with wine or porter, and a nourishing diet. After 
some time recourse should be had to slight exercise, air, 
sea-bathing, and a general system of hygiene. 



CHAPTER IV. 

SORE NIPPLES SCANTY AND PROFUSE SECRETION OF MILK" 

MILK-CONSUMPTION RETENTION AND ALTERATIONS OF 

THE MILK. 

Sometimes, particularly in females with first children, 
the nipples become excoriated or " chapped." This arises 
from forcible sucking of the infant, from the state of 
moisture in which these parts are kept, and from friction 
of the clothes. 

To prevent, as well as to cure, this affection, the nip- 
ples should be washed twice a day with soap and water, 
and dried ; for the excoriation, a lotion of borax, or some 
other astringent, should be frequently applied, and fol- 
lowed by a little powder of elm bark. Should there be 
much inflammation, emollient fomentations and poultices 
will be necessary, which may be followed by some sim- 
ple cerate — the popular remedy of wax, and fresh butter 
answers a good purpose. Certain shields, made of india 
•rubber and other substances for the child to draw through, 
will often relieve the irritation. The child may be nurs- 
ed, notwithstanding the use of remedies, and care should 
be taken that the milk be not -allowed to accumulate too 
much, which may give rise to inflammation and abscess 
of the breasts. Exposure to cold air and friction of the 
clothes should be avoided. 

The quantity of milk secreted varies much in different 
women ; there are some who cannot support one child, 
while others can nurse several. When there is an exu- 
berance of milk, it is of no consequence, unless the wo- 
man's health be affected. The secretion may fail, either 
wholly or in part, in consequence of a want of develop- 



MILK CONSUMPTION. 333 

rnent of the mammary gland, debility, violent emotions, 
hemorrhages, leucorrhea, bad digestion, abuse of venery, 
menstruation during the lactation, chronic disease, as 
phthisis, the application of astringents to the breast, and 
acute diseases ; — these causes may lessen or completely 
arrest the secretion of milk. 

In many instances, a failure of this secretion is beyond 
the resources of art; in others, as where the woman is 
weak and emaciated, the difficulty may be often removed 
by means of tonics, a nutricious diet, and by means of 
frictions to the breasts, either dry or aromatic. At the 
same time the condition of the stomach and bowels must 
be atteuded to, and any known cause or disease that ex- 
ists, removed. Where all proper means are unsuccessful, 
the woman should abstain from nursing her child. Very 
young women, and those who are advanced in years, give 
milk in smaller quantity, and that which is not so good as 
others. The secretion of milk is often suspended, and 
sometimes completely dried up, from the effects of anger, 
fright and violent grief. 

By m;lk-consumption is designated & too abundent se- 
cretion of milk, which is accompanied by emaciation and 
loss of strength on the part of the mother. There may be 
merely an exuberance of milk attended, perhaps, by pains 
in the back, slight lassitude, loss of sleep, and thinness of 
the milk, which is digested badly by the child : this may, 
in^general, be remedied by exercise, a vegetable diet, the 
use of pure water simply, a less frequent application of 
the child to the breast, slight purging, and by diuretic and 
sudorific drinks. The practice of eating for two, as it is 
termed, during lactation, is highly pernicious. 

Cut when the profuseness of milk is preceded by loss of 
appetite, pain in the chest, burning sensations in tho 
stomach and throat, and lastly, by loss of strength and 
emaciation, it is known as nurse's consumption, and 
may result in serious consequences, unless obviated. It 
generally appears in those who nurse too long, or those 
who persist in suckling when the constitution is unfit for 
it. This may be remedied by weaning the child, the use 
of food of easy digestion, moderate exercise and agreeable 



384 RETENTION OF THE MILK ALTERATIONS. 

diversion, slight purging, mineral waters, frictions to the 
mammae, bathing, the use of sedative drinks and tonics, 
according to circumstances. Involuntary discharge of 
the milk, requires the use-; of tonics, astringent applications 
to the nipples, and when there is excessive sensibility, 
of sedative drinks. 

Retention of the milk — This sometimes happens in 
consequence of excessive secretion without augmentation 
of the excretion, and again, when there is malformation of 
the nipple which is generally incurable. The breasts 
become distended and painful, and contain hard lumps : 
true inflammatory engorgement may supervene, unless 
prevented by appropriate treatment. The indications are, 
first, to have the breasts emptied by a vigorous child, or 
an adult, or else by a young puppy, or lastly, by the breast 
pump. The breasts should be kept warm and at rest, the 
patient restricted to a low diet, and laxatives with diuretic 
and diaphoretic drinks should be used. Should inflamma- 
tory symptoms appear, emollient poultices must be ap- 
plied ; and finally, if the female be entirely incapable of 
suckling, active purging in addition will be necessary, to 
obviate, as far as possible, the secretion of milk. 

Alterations of the milk — It assumes a yellowish 
color in inflammations of the breast, a saltish taste in 
general inflammatory diseases, and after nervous affec- 
tions, becomes thin like water or of a greenish color. • It 
contracts the odor and color of certain substances when 
eaten by females : as garlic, madder, etc. Menstruation 
during lactation renders the milk thin while pregnancy 
renders it thick and unnourishing for the child. Salt meats, 
highly-seasoned food, salad and fruits, render the milk 
«more abundant, but thinner; spirituous drinks, excessive 
sleep, late hours, and abundant excretions, on the con- 
trary, diminish this secretion ; very young and aged wo- 
men always have milk of inferior quality. 

All these variations have an unfavorable influence upon 
the child, and are the cause of the destruction of a large 
number of children in all classes of society ; they should,, 
'^refore, be obviated as soon as possible. This -may, in 



INFLAMMATION OF THE BREASTS. 38fc> 

general, be effected by changing the diet of the nurse ; by 
curing the affections which give rise to alterations ; by an 
appropriate system of general hygiene ; and, lastly, by 
changing the nurse, or by weaning the child when of 
proper age. 



CHAPTER V. 

INFLAMMATION and abscess of the BREAST CAUSES 

SYMPTOMS AND TREATMENT. 

Inflammation of the breast occurs most often four or 
five days after delivery ; it may, however, be developed 
at any time during lactation, or at the period of weaning. 
It makes its appearance mostly in those who have a great 
flow of milk, who endeavor to avoid suckling, who wean 
suddenly, and in those who have too long or too short nip- 
ples ; — and is caused by'the engorgement of milk where 
its excretion is difficult from any cause, the action of cold, 
excessive heat, astringent applications, mental emotion, 
and violence. Generally, but one breast is affected ; but 
sometimes both are attacked at the same time, or again, 
successively. The severity of the symptoms will depend 
upon the extent of the inflammation : there are generally, 
chills, heat, local pain and soreness, with a circumscribed 
hardness, a quick and full pulse, headache, thirst, etc. 

Simple engorgement, generally, terminates in resolu- 
tion ; but the more inflammatory kind is liable to end in 
the formation of abscess; it also, sometimes, passes into 
cancerous induration. (See Cancer of the Breast, Book I.) 
The formation of matter is marked by shivering, throbbing 
pains, and fever of an intermitting character ; there is 
fluctuation in the tumor, which generally points in the 
neighborhood of the nipple, and if left to itself a sufficient 
length of time, discharges. New abscesses sometimes 
form beneath the first, which dispose to others even, and 
the patient may sink from protracted suffering. 

Treatment. — The preventative treatment consists in 
the eariy application of the child to the breast, and in the 



386 INFLAMMATION OF THE BREASTS TREATMENT 

avoidance and removal of causes ; or the breasts should 
be drawn by art adult, or by the glasses made for that 
purpose ; by purging ; keeping the breasts warm ; by 
frictions of oil, or a poultice of flax-seed meal and water, 
containing soap, and a little sub-carbonate of potash. 
Nothing astringent should ever be applied. 

When there is much inflammation, with heat, pain, etc., 
recourse should be had to venesection, followed by the ap- 
plication of leeches, and the use of cold emollient and 
narcotic poultices or lotions ; saline purging, with a little 
tartar emetic ; rest in bed ; a low diet ; and in nervous 
females, by sedatives ; the milk should be drawn at inter- 
vals, and the breasts supported in a sling. These means 
have for their object, to prevent the formation of matter. 

But when, notwithstanding these exertions, suppuration 
takes place, we should facilitate the piocess as much as 
possible by the application of warm emollient poultices — 
of elm, flax-seed, or bread, which should be frequently 
repeated. The bowels must be kept free, and opium 
given to relieve pain and procure sleep. When the for- 
mation of matter is perceptible from the fluctuation, an 
opening should be made for its discharge, lest it spread 
and form sinuses in different directions; a little lint may 
be introduced to prevent its closing too soon. The poul- 
tices, with the addition of soap and alkaline solutions, 
may be continued for some time longer. We should here 
remark, that if the engorgement terminate in induration, 
it should be treated as directed under Cancer of the Breast. 
(See that Chapter.) Finally, the patient should be sup- 
ported by a nourishing diet, and if necessary, by the use 
of tonics, as bark, quinine, or bitter infusions, and wine 
or porter. If other abscesses form, they must be treated 
fa the same manner. 



PART III. 

INFANCY. 



CHAPTER I. 

IN WHAT MANNER THE CHILD MAY BE INFLUENCED BEFORE 
ITS BIRTH BY HEREDITARY CAUSES. 

We remarked, when speaking of the development of 
the foetus, that the child, before its birth, may be consid- 
ered as a part of the mother's organization. Although no 
direct nervous connection has been observed to exist be- 
tween them, it is known that the life and growth of the 
child are wholly dependent on its maternal system ; the 
same blood, whether pure or impure, which circulates in 
her blood-vessels, also carries nutrition and growth to the 
child. These processes are so closely connected in the 
two beings, that when the maternal source of supply is 
cut off by cessation of her functions, the child also dies ; 
and every powerful impression made upon her system, 
every change in her health, extends to her offspring in em- 
bryo. 

These are important facts, and of the greatest moment 
to the human race : the reality of hereditary influence is 
no longer doubted. The child receives its organization, 
either good or bad, physical and mental, from its parents. 
It is well known that a father whose system has become 
debilitated, or impressed by any disease, communicates a 
similar affection to his offspring : the mother, also, trans- 
mits her infirmities in the same manner, and seems to 
have a more marked influence upon the organization of 
the child than the other parent. The most prominent and 
fearful diseases in the list, which are thus transmissible, 

387 



388 HEREDITARY INFLUENCE ON THE CHILD. 

are tubercle or scrofula, only one form of which is pul- 
monary consumption ; insanity, dyspepsia, gout, and can- 
cer ; and there is no doubt in our own mind that the pre- 
disposition to most of the obstinate chronic diseases which 
afflict mankind, are imparted in the womb ; the parents 
first impressing their own systems with diseases by in- 
fringement of the organic laws, and then transmitting them 
to future progeny : thus, in the language of Scripture, 
" the sins of the parents are visited upon their offspring, 
even to the third and fourth generation ;" and we might 
ajld, much beyond, unless the disease be arrested by cross- 
ing the races, and then by much care in after-life, — or the 
race become exterminated, which is the tendency of such 
flagrant infraction of the laws of nature. 

Infirmities, or debility of constitution in parents, then, 
are transmissible to their offspring. Parents frequently 
live over again, remarks Dr. Gregory, in their offspring. 
For children certainly resemble their parents, not merely 
in countenance and bodily conformation, but in the gene- 
ral features of their minds, and m both virtues and vices. 
Combe remarks, that those who desire bodily and mental 
soundness in their offspring, ought carefully to avoid in- 
termarrying with individuals who are either feeble in con- 
stitution, or strongly predisposed to any very serious 
disease: and above all, the greatest care should be taken 
against the union of the same morbid predisposition in both 
father and mother. By improving the health of the 
parents, when such unfortunate circumstances exist, the 
future offspring, will, of course, participate in their in- 
creased vigor. 

Besides the direct inheritance of an infirm constitution, 
• there are many other causes which may deteriorate the 
race. The union of parents too nearly allied in blood, is 
a prominent cause, as is seen among some of the royal 
families of Europe, and also, in private life. Marriage 
before the full maturity and development of the constitu- 
tion, particularly in delicate females, as well as great 
disproportion in age between the parents, are prominent 
causes of infirm health in children. The state of the 
parents at the time of conception, has also been observed 
to permanently influence the health of their offspring. It 



INFLUENCE OF THE MOTHER ON HER CHILD. 389 

is highly probable that even temporary disturbance of 
health at this time, will have this effect. u Anxiety of 
mind or unusual depression of spirits in the father," re- 
marks Dr. Combe, M have been found imprinted in inef- 
faceable characters on the organization of the child ; and 
not a few instances are known, in which idiocy in the 
offspring has been the result of accidental intoxication on 
the part of a generally temperate father. I have lately 
heard of an unequivical case of this kind ; and a stronger 
motive to regularity of living, and moderation in passion, 
can scarcely be presented to a right minded parent, ihan 
the simple statement of their permanent influence on Tiis 
future offspring. Many a father has grieved over, and 
perhaps resented, the distressing and irreclaimable follies 
of a wayward son, without suspecting that they actually 
derived their origin from some forgotten irregularity of 
his own." 

Also, besides temporary affections, drunkenness, de- 
pression of spirits, habitual dyspepsia and bilious com- 
plaints, in either or both parents, we should mention as 
among the most important causes which affect the condi- 
tion of the future infant, the health, state of mind and 
conduct of the mother during pregnancy. These are so 
important that we shall devote a separate chapter to their 
consideration. 



CHAPTER II. 

INFLUENCE OF CERTAIN CONDITIONS IN THE MOTHER ON THE 
HEALTH AND CHARACTER OF HER OFFSPRING DURING PREG- 
NANCY. 

Although popular belief has gone beyond the real 
truth in always ascribing moles, or the mother's mark, as it 
is called, to her imagination, as it may be produced by other 
causes (as we have before shown,) yet, there are many 
proofs of the reality of the mother's influence on the con- 
stitution of her child unborn : some of these we alluded to 
in the last chapter. It is known beyond a reasonable 
18 



390 INFLUENCE OF THE MOTHER ON HER CHILD. 

doubt, that strong mental emotion, distressing anxiety, 
violent agitation of body or mind, may and do prevent a 
proper development of the foetus. If the lungs, brain, 
stomach, intestines, or other parts be but imperfectly form- 
ed, they will in after life, be liable to be affected by dis- 
ease from causes which, otherwise, would have no influ- 
ence. This shows the importance of pregnant females, 
leading a tranquil life and avoiding all violent, mental and 
bodily agitation. We believe there are but few mothers 
who would not deny themselves of impulses and gratifica- 
tions, were they convinced that in proportion as they in- 
dulge, in the same ratio, is the chance of injury to be 
sustained by the new being within their bosom ! 

That severe mental perturbation in mothers during 
pregnancy, frequently gives rise to a morbid timidity oi 
character, and even to nervous and epileptic diseases in 
their children, is proved by numerous well-known instan- 
ces. 

A single member of a family is sometimes observed to 
be thus affected, which cannot be otherwise accounted for. 
The constitutional aversion to weapons, and danger of every 
kind, shown by James I., of England, is ascribed, and not 
without reason, to the constant anxiety and apprehension 
under which Mary lived during the period of gestation. 
So, the philosopher Hobbs ascribed his own excessive 
nervous sensibility and timidity to the fright in which his* 
mother lived, on account of the threatened Spanish inva- 
sion, which upon news of the approach, brought on pre- 
mature delivery. The last case in illustration of this 
subject, which we shall mention from among many simi- 
lar ones, is that recorded by Baron Percy, an eminent 
French military surgeon, as having occured after the siege 
of Landau, in 1793. The women of the town were kept 
for some time in a constant state of alarm, by a violent 
cannonading, when the arsenal blew up with a terrific ex- 
plosion. Out of 92 children born within a few months 
afterwards, Percy states that sixteen died at birth ; thir- 
ty-three languished for from eight to ten months, and 
then died ; eight became idiotic, and died before the age 
of five years ; and two came into the world with numer- 
ous fractures of the bones, caused by the convulsive starts 



INFLUENCE OF THE MOTHER ON HER CHILD. 391 

of the mother excited by the fright. So that about two 
out of every three, were actually killed through the me- 
dium of the mother's alarm ! 

These instances, with much other evidence, are suffi- 
cient to establish the existence of a direct relation between 
the general condition of the mother, and the general con- 
stitution of her child. This, indeed, is not wonderful: 
as the child in the womb is virtually a component part, for 
the time, of her own body, it necessarily follows that 
whatever affects the general health and action of the sys- 
tem, must affect all its parts. If by anxiety of mind, or 
neglect of her health, digestion be impaired, and her blood 
rendered impure, how can it be otherwise than that the 
health of the infant must suffer, seeing that it is nourished 
by the same deteriorated blood which is insufficient for her 
own health ? 

It was believed for a long time, and is at present by 
some, that the longings or imagination of the. mother, is 
the principal cause. of the marks and deformities with 
which some children are born ; but it has been shown that 
in many cases, there is, in reality, no coincidence between 
the object longed for and the nature of the deformity. In 
many cases, longing is followed by no mark in the child, 
while the latter sometimes occurs where no particular 
longing was experienced by the mother. And though de- 
formity may occur in consequence of a strong impression 
made by some dreadful object upon the mother, in gene- 
ral, the true cause is of a deeper kind, affecting the whole 
economy. It is in this manner that good or bad temper, 
sound or broken health in the mother, exert a constant 
and positive influence on the offspring. The ancient 
Greeks seem to have understood this : pregnant females 
were by them held sacred ; no one, under a severe penal- 
ty, was allowed to disturb or vex them ; their chambers 
were provided with the most beautiful specimens of sculp- 
ture and painting, such as the figures of Apollo, Narcis- 
sus, Castor and Pollux, etc., that they might dwell upon 
their fine proportions, with that complacency of spirit, 
which beautiful objects always inspire. For the same 
reason, the Spartans took their wives to the battle field, 



392 INFLUENCE OF THE MOTHER ON HER CHILD. 

that their children unborn, might be influenced by the 
songs and triumph of victory. 

An eminent medical writer has made the following very 
true and judicious remarks : " By many women, pregnan- 
cy is regarded with alarm, as a period full of danger, and 
worse than doubtful in its result. But it is a consolation 
to know, that this period is not naturally fraught with 
danger, but is rendered perilious only, or chiefly, by neg- 
lect or mismanagement. From the moment of conception, 
if there is one duty more paramount than another, it is 
the obligation. on the part of the mother to secure for her- 
self by every possible means , the highest state of mental and 
bodily health of which her constitution is susceptible ; and 
this is the more binding upon her, that its performance 
involves no sacrifice which is worthy of the name, and 
none which is not amply cdmpensated to her by its favora- 
ble results. 55 

The condition of the mother, then, exercising a marked 
influence upon the health and intellect of her offspring, it 
behooves her to contribute, by a well regulated system of 
physical and mental hygiene, to her own health, cheer- 
fulness, and comfort — at the same time avoiding the indul- 
gence of appetite, indolence, the excitement of passion, 
violent exercise, and in short every kind of excess and 
social dissipation. There is nothing of so much conse- 
quence for a pregnant woman, as to observe moderation 
and simplicity of diet, and avoid the use of heating food 
and stimulants. Next to this, it is important that the 
mother engage in some healthy and invigorating occupa- 
tion, which shall properly employ her intellectual, moral 
and physical faculties, and divert her attention from her- 
self. Gloomy and harrassing impressions should be 
guarded against ; she should breathe a free and pure air ; 
sleep in a large and well-ventilated room, on a bed neith- 
er too soft nor hard, and without curtains ; she should 
give great attention to cleanliness ; take regular exercise 
in the open air ; and, finally, dress loose, avoiding every 
species of compression of the breasts, waist, and abdomen. 
As we have treated of these subjects elsewhere, further 
remark here is unnecessary. (See Chapter on Hygiene, 
and Management of Pregnant Women.) 



HYGIENE OF INFANCY. 393 

Before closing this chapter we should advert to the 
prevalent notion, that an unusual supply of food is requir- 
ed during pregnancy, on account of the growth of the new 
being, derived from the maternal system. Now, although 
it is true that the mother imparts nourishment to the foetus, 
yet nature herself has made provision for that demand by 
the suppression of the menses, to which women are at 
other times subject. When, therefore, during pregnancy, 
the health is good, there is no need of increasing the 
quantity or changing the quality of food, unless it be made 
more simple, which is, indeed, generally required ; noth- 
ing but evil can result from attempting to sustain strength 
for two, by too nutricious a diet. Yet, it is proper to re- 
mark that the opposite extreme should also be avoided, 
that is, an insufficient diet. "Child-bearing is a natural 
and not a morbid process ; and in the facility with which 
healthy, regular living women pass through it, we have 
abundant evidence that the Creator did not design it to be 
necessarily a time of suffering and danger. Where the 
mode of life and the habitual occupations of the mother 
are rational, the more nearly she can adhere to them dur- 
ing pregnancy, the better for herself, and consequently 
the better, also, for her infant." 



CHAPTER III. 

HYGIENE AND MANAGEMENT OF INFANCY AND CHILDHOOD. 

Ushered into a world where everything is absolutely 
new to it, and where its safety depends at every instant 
on its proper treatment, the infant is thrown at first entirely 
upon its mother for support and protection, and these are 
secured to it by the strongest feeling which woman can 
experience, — that devoted love of offspring which seldom 
fails even amid the agonies of death. Ignorant of its own 
nature, and of everything around it, the infant is wisely 
denied a power of motion or action which it could use only 
to its own detriment. Unable as it is to act for itself, 
ripened consciousness would have added miseries to its 

R 



394 HYGIENE OF INFANCY CLOTHING. 

lot, without a single compensating advantage ; and, there- 
fore, it passes its earlier days in sleep, and dozing, and 
wakes up only for a moment to satisfy its predominating 
instinct, — the appetite for food, on which its future deve- 
lopment depends. — Combe. 

As we have previously spoken of the development of 
the child before its birth, and pointed out the causes which 
may influence it, also the mode of detaching it from the 
mother, and its treatment at birth, there only remains for 
us to consider briefly, the clothing, food, exercise, air, 
sleep, intellectual and moral training, etc., which are best 
adapted to secure a healthy childhood, and lay the founda- 
tion for a vigorous maturity. 

CLOTHING. 

The principal qualities required in the dress of infants, 
are lightness, looseness, softness, and warmth. The for- 
mer practice of swaddling the infant like a mummy, is so 
inconsistant with known principles, that we need scarcely 
mention it. Whatever tends to compress the body, legs 
or arms, should be emphatically forbidden. The dress 
should always admit of being easily applied and changed ; 
and while it affords protection to the whole body, it ought 
to admit of the fullest expansion of the chest and abdomen, 
and freedom of motion in the limbs and joints. 

For dress in winter, flannel is preferable, but not next 
to the skin. For the first few months, the clothing should 
be long and flowing so as to protect. the feet; but after 
there is desire for motion, this should be changed and the 
feet dressed in warm stockings and easy shoes. The 
neck, shoulders, and anus should not be left bare, as is 
practiced by many, for it is attended with the greatest 
risk and actual danger. The head is commonly kept too 
warm : the thinnest possible covering is sufficient, except- 
ing when the child is carried into the open air. 

Our remarks concerning dress apply equally to the 
bed-clothes to be used during the many hours of sleep, 
which are very often injurious from overheating the child. 

The evils of tight-lacing having been generally made 
known, we shall here take leave of this subject by re- 



MANAGEMENT OF IXFACNY FOOD. 395 

marking that the principles of dress here laid down, what- 
ever may be the style, should not only be observed dur- 
ing childhood, but throughout life. 

FOOD AND DRINK WEANING. 

The natural food of the infant, from the time of birth 

until its teeth appear, is the milk of its mother : 

" She who to her babe her breast denies. 
The sentient mind, the living man destroys." 

When from any cause, the mother is forced to desist from 
nursing, she had better procure a substitute. A nurse 
should be selected with sound health, free from hereditary 
taint ; who is temperate, cheerful, orderly ; one whose 
child is of about the same age, and who is of a tempera- 
ment similar to the mother's. 

We have already spoken of the quality of milk which 
is best adapted, and that which is least so, for the nourish- 
ment of the child, and of the means, of obviating all al- 
terations. (See Chapter IV., Section II., Part II., Book 
II.) The same general regimen should be observed by a 
woman who is giving suck, as has been directed for her 
during pregnancy. (See the Hygiene and Management 
of Pregnant Women.) Her diet should be simple but 
nourishing, with an avoidance of highly-seasoned food 
and stimulating drinks. She should also take sufficient 
exercise and sleep ; attend to all the bodily functions, and 
avoid excessive emotion and passions, as they may prove 
hi^hlv detrimental to the child which she is nourishing. 

If the mother or nurse be able to supply milk in abund- 
ance, and the child continue healthy, more solid food will 
be injurious until the appearance of the teeth. After this 
event, which occurs from the seventh to the tenth month, 
and before, if the nourishment derived from nursing be 
insufficient, boiled milk, diluted with one-third or half 
tepid water, according to the age, and slightly sweetened, 
may be used ; or, recourse may be had to thin barley- 
water, arrow-root, tapioca or panada. The administration 
of medicines to infants is a frightful source of mortality, 
and should not be resorted to without the advice of a com- 
petent physician. 



396 MANAGEMENT OF INFANCY EXERCISE, ETC. 

As a general rule, the child should be weaned at the 
age of nine or ten months ; — before, if the mother be af- 
flicted with scrofula or any other disease, or it should not 
nurse at all ; — *but later, if the infant be. weakly or sickly. 
After weaning, the diet should consist of the above named 
articles, to which may be added pulverized crackers or 
portions of bread and simple liquids. Care should be 
taken not to overload the stomach. By degrees (it should 
never be hurried') the stomach is brought to bear more 
solid substances. 

" Regulation of the food," remarks Dr. Warren, " is 
of primary consequence towards the formation of a good 
constitution. The most common error in relation to it, 
consists in the use of too much. Parents are uneasy 
when their children eat but little, and would encourage 
them to eat against their inclination. No mistake can be 
more pernicious to health ; and if persevered in, disease 
will, infallibly result from it. .When the child wants ap- 
petite, instead of bemg compelled to take food, it must be 
compelled to take exercise, unless positively ill, and then 
it muBt be compelled to take medicine. The quantity of 
liquid given to young persons is decidedly injurious. Ani- 
mal food should be sparingly taken by young persons who 
use little exercise ; and children generally do not need it. 
Bread and milk, and fruit, are the best articles for those 
who do not labor. Wine is highly pernicious to young 
persons. It is a slow but certain poison. Before the 
body has attained its full growth, there is an overplus of 
excitability ; and if to this is added the powerful agency 
of wine, or any other stimulating drink, the constitution 
cannot fail to be hurt. Females are more injured by stim- 
ulating drinks than males, because their svstem is more 
susceptible to physical excitement." 

EXERCISE, AIR, SLEEP, BATHING, INTELLECTUAL AND MORAL 
TRAINING, ETC. 

The powers of the system during the first month or two 
of infant life be;'ng occupied in nutrition, the time of the 
child is principally spent in sleep and taking nourishment. 
Exercise, during this period, of course, can only be of a 



MANAGEMENT OF CHILDHOOD — AX£-~GA?HJNG.. 397 

passive kind. There should never be any haste to excite 
a child to premature exertion, or to endeavor to make it 
sit and stand. During the early months, therefore, exer- 
cise should consist in carrying the infant gently about the 
nursery, or into the open air, and in gentle friction with 
the hand over its whole surface. Afterwards, with pro- 
per precautions, it may, in pleasant weather, ride in a 
carriage. The length of time spent in sleep should be 
left mostly to the natural inclination of the child : repose 
should not be too much enforced by rocking, or moving 
lullabies. The quack " cordials" and " anodynes," given 
for the purpose of procuring sleep, are ofteu highly inju- 
rious, and ought to be dispensed with. 

Pure air is quite as essential, to the formation of a good 
constitution as proper food ; and it would seem even more 
so, when we consider that the influence of the air we 
breathe never ceases for a single moment of our lives. 
Vitiation and deprivation of air, are justly reckoned among 
the most common causes of scrofulous disease and mor- 
tality in infants. The nursery, and rooms devoted to 
sleep, should, therefore, be elevated, large, airy, and easi- 
ly ventilated. The practice of crowding several children 
and nursery maids into a small room, in which also wash-- 
ing and cooking are sometimes carried on, is highly inju- 
dicious, and at variance with the duty of parents to the 
welfare of their children. Overheating such rooms is 
also very injurious. For the same reasons care should 
be taken that the infant does not slip beneath the bed- 
clothes, and thus cut off the most important source of vi- 
tality during its sleep : the head should always remain 
uncovered. Plants, flowers, and perfumes ought to be 
wholly banished from a sleeping apartment. We need 
not remark that the night and bed clothes should be, daily, 
thoroughly aired. 

Frequent bathing in infancy is of the first importance 
to health. The whole surface of the body, and particu- 
larly the foldings of the skin and joints, should be care- 
fully washed every morning in tepid water, and diied by 
gentle rubbing with a soft napkin. The best time for 
such ablution is when the child is first taken out of bed : 
in hot weather, it may be repeated with advantage in the 
evening. Cold water for this purpose has been justly 



308 MANAGEMENT OF CHILDHOoi)— EXERCISE, ETC. 

condemned, as exposing the infantile frams to a sudden- 
change of temperature, which it is not able to bear. The 
strictest cleanliness must be observed in immediately re- 
moving every soiled article of dress. 

Sufficient exercise and pure air are indispensable condi- 
tions of health. As soon as children are able to creep 
and walk, they should* not be in the least restrained— 
though care ought to be taken to guard against improper 
exposure. In fine weather a child cannot be too much in 
the open air, exercising .its muscles in its own way. Ear- 
ly attempts at walking, by the aid of an attendant, as we 
have before intimated, ought to be forbidden. 

Had we room, we should here speak of the' depressing 
influence of parental severity. That most abused of all 
sayings, "Spare the rod," etc., often leads to the most de- 
plorable results. Stern language even, and restraint of 
motion, song, laughter, and sport, in children, are the 
causes of much suffering and permanent injury. We 
should also advert to the influence of an upright form and 
full chest on the health, which are to be acquired by an 
appropriate system of physical education. Too much of 
the time of young persons is devoted to literary pursuits 
and sedentary occupations, and too little to the acquisition 
of corporeal vigor. 'For further information on these sub- 
jects, we must refer the reader to Combe on Infancy, 
Warren on the Preservation of Health, and Dewees on 
Children, all of which are excellent works, and should be 
read by every mother. 

" If more time were devoted to air and exercise, and 
less to mere accomplishments — if less strenuous efforts 
were made to cram much ill-assorted knowledge into the 
mind in a very limited period — than usually is the case 
in the present day, an improved state of nervous energy 
and of constitution generally would result. There would, 
consequently, arise a race of females possessed of stronger 
minds, and better able to make good wives and healthy 
mothers, than those too frequently met with in the easiei* 
ranks of life. Of all the physical influences by which 
the human constitution is permanently impressed in early 
age, there are none so powerful as light, air and exercise. 
Females, while the frame is being developed, should 
strictly observe early hours,- so that the period of repose 



MANAGEMENT OF. CHILDHOOD CONCLUSION. 399 

L, /M. never be prolonged much after the dawn of morn- 
ing. The propriety o? deeping in a large, well-ventilatea 
room, cannot be diluted. It will be prudent, where 
more than one mv I sleep in the same apartment, to have 
separate beds, each no larger than is necessary for one 
person. v We should add that walking, dancing, riding 
on horse hack, the use of the triangle, the plays at ball 
with both hands, dumb bells, and battledoor, are the best 
rwues of exercising, where useful occupation is insuffi- 
cient ; — to be employed so as to urn *rate without ovcr- 
fatiguing. Young persons ought n<5ver to sleep with the 
aged, or infirm. For a bed, a matress, not too soft, is the 
best : the bed-clothing should be light. The constant use 
of frictions and bathing in cold water, over the wnole sur- 
face of the body every morning, should not be neglected. 
The food should be simple, and contain a sufficient quan- 
tity of unnutricious matter. There are other cares which 
the young girl requires as she approaches the period of 
puberty ; but of these we have already spoken at length. 
(See Chapter I., Part III., Book I.). 



We will conclude by entreating the attention of moth- 
ers and others to a revision of our present .modes of living. 
Our organization, both physical and mental, is regulated 
by unchangeable laws ; — laws as fixed and never-varying, 
as those which regulate the motions of the planets in their 
orbits. Let females timely make friends of worthy phy- 
sicians,— those men, who, in every age of the world, have 
with untiring zeal labored for the good of mankind, and 
to whom we are indebted for all our knowledge concern- 
ing the prevention and cure of disease. At the same time 
let the female avoid empiricism in all its alluring forms ; 
and by the. aid of the educated physician she may hope, not 
only to be able to ascertain the laws of health, — but by 
an early resort to the preventative and curative means, 
which experience has proved to be efTic^c.ous,^ — she may 
also hope to bt able to cure most of the diseases l/s which 
she is incHent : Principiis obsta : sero medevwa parat&* 
cum muia per longas involucre moras. — Ovid* 

*The principles of art are hindered ; medicine is furnishe J too lat% 
when disease is aggravated by long delay. 



BOOK III. 



ELEMENTS 

OF 

WOMANHOOD AND MANHOOD: 

LOVE, MARRIAGE, 

AND 

HEREDITARY TRANSMISSION. 



11 A book about marriage for the family ? Scandalous I Rather write 
thirty romances about adultery — something imaginative, something 
amusing. You will be much better received." — Michelet. 



ELEMENTS 

OF 

WOMANHOOD AND MANHOOD. 



CHAPTER I. 

ELEMENTS OF REPRODUCTION IN THE SEXES. — WOMANHOOD. — 
MANHOOD. 

THE MASCULINE AND FEMININE ELEMENTS OF REPRODUC- 
TION pervade the universe, extending alike to the animal and 
vegetable kingdoms. The blending of these two elements con- 
stitutes the creative or reproductive power of plants and flowers 
as well as insects and animals, and is subject to certain fixed 
natural laws. These laws must be known and observed, in order, 
by culture, to produce a more beautiful, healthy/ and perfect model 
in plant or animaL . 

The object of sexual distinction in the human race, is the 
reproduction of human beings as perfect, physically and intel- 
lectually, as belong to the species. Plants, flowers, and fruits, also 
domestic animals, are improved and perfected by culture ; and why 
not the human race ? Man alone is neglected, or, rather, neglects 
himself. 



Knowledge Required. — To improve, beautify, and ennoble 
fchfi human race, and produce a more exalted manhood and woman- 
hood, ought to be the object of science and religion. What power 
have parents over the organization of their children — their bodies 
as well as their souls ? Look, ye fathers and mothers, at your 
deformed and suffering progeny ! This is your work ! Will you 
transmit to your children healthy or diseased bodies ? What kind 
of souls — true or false, loving or hating ? 

(403) 



404 ELEMENTS OF WOMANHOOD AND MANHOOD. 

It is conceded that man needs a certain amount of knowledge 
to enable him to cure disease. How much more important, then, 
that he should be educated so as to be able to prevent disease! 
Where there is no violation of natural laws, there is no disease. A 
perfect organization and development is the right of every child to 
demand of its parents. 

To the Laws of Reproduction must we look for the improvement 
of our race, to expel disease from the body and soul. No religious, 
social, or political prescription will avail anything. A new man- 
hood and womanhood must precede the reorganization of society. 
How health, beauty, and strength can be substituted for disease, 
feebleness, and deformity both of soul and body, we shall proceed 
to indicate. 



Sexual Elements. — The distinctive characteristic of a woman 
is such as to qualify her to become a mother, and that of a man 
to become a father. Neither sex can reproduce without the other. 
The ovum," or germ, as has been seen, is already formed in the 
matured female ; but it is the semen secreted by the male organism, 
which, by coming in contact with the ovum in the womb, impreg- 
nates it, and causes it to become a living being. These are known 
as the sexual elements ; and this process is called conception, and is 
contributed to alike by each, man and woman. 

Take away the sexual element from a man, and he is no more 
attached to a woman than to a man, and vice versa. It constitutes 
the great attraction of one for the other, and is the ever present 
bond which binds them together. Each needs the aid of the other, 
not only to reproduce, but as the basis, when properly directed, of 
the most exalted social relations. 

The reproduction of the species, then, is the object of sexual 
distinction, and to satisfy the social wants of man and woman. 

Formation of the Soul. — The process by which the body of 
the child is formed during gestation, or pregnancy, is quite plain and 
obvious, after reading the chapters of this work devoted to those 
subjects. The agency of the parents is made visible, and connec- 
tion between the mother and child* actually known. But from 



ELEMENTS OF WOMANHOOD AND MANHOOD. 405 

whence comes the human soul? Is it also derived from the parents, 
as is the body ? If so,, is not its constitution more or less influenced 
by, or under the control of, its progenitors 1 According to the 
modern Spiritual theory, the soul is a substance, though composed of 
matter so refined as to be invisible, like electricity. 



Do not Waste the Sexual Element. — At the period of 
puberty, then, the semen, otherwise known as the spermatic fluid 
of the male, and ovum or germ of the female, are secreted and 
elaborated in their natural organs, for the purposes of reproduction. 
These elements of procreation are the most refined product of every 
portion of the human functions, body as well as soul, and require 
for their perfect formation, the utmost harmony and vigor of our 
entire organization. The retention of these elements in the system 
is necessary to produce perfection of health and beauty in man and 
woman. They constitute the manhood and womanhood of the soul 
as well as body. The expenditure of these elements, except for 
procreation, is useless ; and when done for sensual gratification, 
particularly before the maturity of all the organs, the energies of 
the body and soul are blasted ; the brain and nerves become ex- 
hausted, and transmit weakness to the muscles and disorder to all 
the functions of mind and body. Thus result loss of memory, loss 
or want of the affections, imbecility of body and soul, idiocy, and 
insanity, 

Says the sensualist, What ! am I to enjoy this expenditure but 
rarely during life ? We answer, The retention of this element in 
the system is an ever-present enjoyment. In case not wasted, it 
becomes re-absorbed into the system, carrying health, beauty, 
energy, and life everywhere, and giving a capacity for enjoyment in 
body and soul, little dreamed of by the victim of passion. 



Solitary Indulgence. — He or she who expends this life- 
element in solitary indulgence, sinks below the brutes, who never 
practise it. And what shall we say of the lewd and lustful, whether 
legally so or not (married or unmarried) ? Which does the greatest 
violence to nature? There is, perhaps, little distinction between 
the two. How manv husbands and wives ruin their own health by 
18* 



406 ELEMENTS OF WOMANHOOD AND MANHOOD. 

. yielding to this sensualism, bringing desolation upon homes other- 
wise full of life and beauty ! How much disease, deformity, and 
weakness transmitted to the bodies and souls of their children ! 

The following case of an erring clergyman and his wife, reported 
by a physician, is here introduced to illustrate our subject, and is 
only one of constant occurrence : — 

"He, a bright young man, educated in a New-England college, 
graduated with honor, and, after a course of theological studies, 
entered the ministry, was ordained, and settled. She, the daughter 
of a merchant, had received a polished education, and was the pride 
of the family. They were married. He was beloved and admired 
for his eloquence. But, after a while, irregularities were discovered 
in his appearance and conduct; something seemed to be wrong 
with him, which was attributed to his devotion to his profession. 
Finally he became insane, was sent to an asylum, grew worse, pro- 
nounced incurable, and again taken to his friends. 

" As for the wife, soon after the husband's insanity, she became 
insane, and was sent to an asylum in another state. She became 
much improved, and returned to her father's house. 

" Upon an investigation by the friends of each, it was discovered 
that the husband had long and fearfully abused his manhood, and 
had long lost the power of self-control, and that it was unsafe for 
him to see his wife, who also felt the same necessity. 

41 The result of this marriags was two children, — a son and 
daughter. The son was a perfect picture of him, and the daughter 
of her. Both were in feeble health, and the most perfect specimens 
of nervous excitability, — the natural and necessary result of the 
great wrong done by their father to himself and their mother. 

" Contrary to all expectation, and contrary to the usual result in 
such cases, after careful and long nursing and treatment, this min- 
ister improved in health, body, and mind, and recovered sufficiently, 
after a long time, to again form a re-union with his wife and chil- 
dren, and resume his profession a wiser man." 

" As the cause of his insanity and unhappiness, he related the fol- 
lowing circumstances: When quite young, at school, in common 
with other scholars, he acquired the habit, and nightly pursued the 
practice of, solitary indulgence by self-abuse. 1 his he continued 
through his collegiate course and theological studies, up to the time 
of his marriage. Several times his health gave way, which was 
imputed to hard study. After marriage, he indulged his sensuality 
so excessively, that his insanity became complete; and his wife, 
pure and healthful when married, became the victim of his lust, 
and also insane. 

" The children begotten under these circumstances were irritable, 
nervous, and weakly, — monuments of sexual abuse, and victims of 
the violated laws of reproduction in their parents." 



LOVE AND MARRIAGE. 407 

Husbands and wives, fathers and mothers, listen to the voice of 
experience and reason. Would you assist in eradicating disease 
and darkness from the earth, and causing it to be peopled by a 
nobler type of beings ? If so, remember, " Knowledge is power." 
Instruct your fellow-beings, particularly the young, and first your 
own children. Teach them the noble uses of all their organs of 
the body, and show them the destruction which awaits any viola- 
tion of their tender nature. Thus, in a word, become ministers of 
grace and angels of mercy to a corrupt and bewildered world. 



CHAPTER II. 

LOVE AND MARRIAGE. 

The Family rests upon Love, says Michelet, and society 
upon the family. Hence, love goes before every thing. In natural 
history, we notice birds and animals tending towards the married 
state. 

Love, the Natural Aim of Woman. — In the human species, 
we see that the natural aim of woman is to first love ; second, to 
love but one : third, to love always. 

As for man, the increasing use of spirits, tobacco, and other nar- 
cotics, obscure his mind, isolating him from love and home, and 
giving him a preference for solitary enjoyment and the dreary 
pleasures of a polygamic life, which impose upon him little or no 
responsibility. This state of things, enervating to man, is debasing 
to woman, he profiting by her misery. 

Woman, unless hindered, is more pure and faithful than man, 
her love continuing in an equal course, like the flowing of a beau- 
tiful river — forever. 



Rescue the Woman. — Happy he who, seeking a companion, a 
partner, or mate for life, rescues a woman from her loneliness, and 
frees her from the weakness and misery of seclusion, and elevates 
her, strengthens her, and makes her his own. In delivering her, he 
also delivers, strengthens, and elevates himself. 



408 LOVE AND MARRIAGE. 

She will Rescue You. — When once set free by you, from 
what will she not rescue you in return ? From the servitude of 
your base passions ! You will not leave home to seek the abodes 
of infamy, nor wander in the streets in quest of love or intoxica- 
tion. Look at that feeble, pitiable, young, old man, so pale, dis- 
eased, melancholy, and debased ! True love will preserve you from 
this, and might have preserved him. 

He who has with him a reliable and loving wife, goes to his daily 
toil strong in purpose and inspired with cheerfulness and content. 
He leaves at home one beloved, to whom he can always return and 
find an open and loving heart ready to greet him and sympathize 
with his disappointments. 

Non-Expensiveness of Marriage. — Many remain single, 
frightened at the expensiveness of matrimony; yet they expend 
much more, after all, than if married. They live expensively at 
the restaurants; frequent the theatres; smoke, and often resort to 
intoxication ; or they contract temporary marriages, secret and 
shameful, lasting sometimes for months, but often only for a week 
or an hour. These, while completing the utter degradation of the 
woman, ruin also the man, physically, morally, and mentally. 
Those infamous diseases infecting the haunts of vice, when con- 
tracted, complete the picture of ruin and despair. 

We say, then, as a rule, that marriage is less expensive than 
living single ; in other words, two persons spend less than one. And 
if the wife be not incited to extravagance in dress by female friends, 
she expends almost nothing ; and we might say, with truth, that 
" four persons spend less than one;" for she supports the two children 
besides. 

A Wife a Fortune. — Young man, if you have a good wife 
and a good trade, you are free. Free from vice and extravagance, 
you can laugh at the hosts of uneasy millionaires. You can say, 
"Let them wear out their lives in amassing riches. I love ; and in 
that, I have found mine." "Do not fear that you will tire of her, 
for she will ceaselessly change. Do not fear to confide in her, for 
she will never change.'" — Michelet. 



LOVE AND MARRIAGE, 409 

Menstruation : Cause ; Purity of. — The period of puberty 
in females, announced by the appearance of the menstrual discharge, 
occurs, in this country, usually between the thirteenth and sixteenth 
years. It is hastened by a warm climate and certain modes of life 
1 n cities, and retarded by a cold climate and living in the country, 
free from the excitement of city life. Seepages 38-84. 

It was believed by the ancients, that woman is impure; that her 
monthly sanguineous discharge was a purgation. Hence, the com- 
mand of Moses, that man should not approach her at a certain 
period of the month. But it has been proven by science, that she 
is pure ; the blood is the same as found elsewhere. It has been 
established that the ovaries exist in woman, and that, each month, 
an ovum or ova matures, burst their envelopes, and make their way 
into the uterus ; so that, every month, this ovarium is ruptured or 
torn, and then subjected to the healing process. Instead of being 
any thing shameful, this periodical function is the most essential of 
her organism ; and upon its regular and healthful appearance, 
depends her health, beauty, and happiness. "What you call a 
purgation, you fools ! is the sacred wound of love, in which your 
mothers conceived you." 

Although a natural and as essential a function of her organism 
as breathing, yet, imperfectly organized as women are in civilized 
life, the recurrence of the menses is generally a period of physical 
and mental prostration. The week preceding this event is. one of 
trouble, more or less ; and in the few days which follow it, there 
exist languor and weakness, now known to be caused by the healing 
of an internal wound. So that woman is an invalid one week out 
of every four ; that is, every woman who does not blot out her sex 
by excessive labor, as the peasant women of some conntries do. It 
is at this time that her nature calls for the tenderest love and 
sympathy of man. 

Knowledge Required. — In early life, men, as well as women, 
should be taught to understand the reproductive functions and the 
relations they bear to her health, beauty, and happiness. They 
ought to know that, upon the regular recurrence of the menses, 
depend her qualifications to become a wife and mother. It should 



410 LOVE AND MARRIAGE. 

be understood by every husband, father, son, brother, and lover. 
Such knowledge would save woman from much suffering, and bind 
the sexes in a tenderer and holier union. 



Should be Acquainted. — Man and woman, previous to 
entering the marriage relation, should be acquainted with the 
mental as well as physical conditions of the person with whom they 
are to be united. Let each ask, Is his or hers a fit physical and 
mental organization to be united and blended with mine ki our 
children ? For the souls of the parents, in their leading tendencies, 
as a general rule, will pass into the souls of their children. 

No man or woman, then, should enter the conjugal relation until 
they become acquainted with the physical and mental constitution 
of the one with whom he or she seeks to be united. It may be 
accounted an insult to inquire into this matter, which is, however, 
of too much importance to be neglected. If your own soul be pure, 
it will shrink from a union with a person deformed with passion, 
mean, cowardly, and avaricious, whose appetites are unnatural, and 
who aspires merely to the gratification of an animal nature. Shun 
such an one for a companion, though they possess untold wealth 
and faces and forms of unsurpassed beauty. Such a marriage will 
crush your moral nature and entail upon your children an eternity 
of degradation. 



Love ; Passion. — As an element of marriage, the passional 
nature should here be adverted to. That there is a distinction 
between love and passion, is obvious. Although marriage love is 
the deepest and tenderest sentiment of the soul, it may not exist 
without passion. Still, they are essentially different unless there is 
a defective organization. In a perfectly organized man and woman, 
the desire for sexual gratification would exist only as the effect of 
pure love, and thence the passional nature would be in abeyance 
and under the control of wisdom and reason. Instead of this, 
however, it is lamentable that love is generally subject to animal 
passion. Men and women — most often, the former — are fearfully 
diseased in this respect. They indulge and seek to stimulate this 



LOVE AND MARRIAGE 41) 

passion to the utmost without love. Reason, conscience, wife, 
children, and life even, are all sacrificed to sensual desire ! The 
inevitable consequence is physical and mental degradation in the 
man and woman and their offspring 

This instinct, when once aroused (even though very obscurely 
felt J, acts upon the mental faculties and moral feelings, and thus 
bec-omes the source, though almost unconsciously so to the indi- 
vidual, of the tendency to form that kind cf attachment towards 
one of the opposite sex, which is known as love. This tendency 
cannot be regarded as a simple passion or emotion, since it is the 
result of the combined operations of the reason, the imagination, 
and the moral fCeliugs ; and it is the engraftment, so to speak, of 
the psychical attachment upon the more corporeal instinct, that a 
difference exists between the sexual relations of man and those of 
the lower animals. In proportion as the human being makes the 
temporary gratification of the mere sexual appetite his great object, 
and overlooks the happiness arising from spiritual communion, 
which is not only purer but more permanent, and of which a 
renewal may be anticipated in another world, does he degrade 
himself to the level of the brutes that perish. Yet, how lamentably 
frequent is this degradation ! — Carpenter, 



Incapacity must be Known. — We have before remarked that 
woman is evidently designed, by her physical and mental constitu- 
tion, to fulfil the relations of a wife and mother: also the husband, 
of a father. Particularly, the man, if well organized and truly 
developed, will seek a woman for a wife capable of crowning him 
with the dignity of progeny. But neither has a right to attract the 
other into the relation of marriage, knowing their incapacity to 
fulfil this deep and holy want of their natures, without a full ac- 
knowledgment of the fact. They may meet as friends, and, if they 
choose, may sacrifice this part of their being to their beloved, but 
have no right to cause this sacrifice by concealment. In the case of 
woman, in a perfect nature, desire does not, at first, take so distinct 
a form as in man : and there are many, perhaps, who would marry 
with a knowledge of incapacity in their husbands. "Well would it 
be for husbands full of passion and vigor, to remember this fact, 
and, when they first approach the loved ones of their hearts, not 
demand a rude consummation of their desires, until, by endearing 
expressions, they induce a cheerful compliance with this con- 



412 LOVE AND MARRIAGE. 

centrated expression of their love. Through sweet tenderness, 
such charming favors will be granted as otherwise might not have 
been conceded. 

Oneness Required. — In true marriage, there is ordained a 
oneness of the flesh — a perfect unity. Lovers should create in 
themselves, by a lifelong study, a common basis of ideas and an 
alliance of their two wills. There should be a free union of hearts 
— an absolute interchange of lives. 

Initiate the Daughter. — Parents should prepare their daugh- 
ter for marriage both physically and mentally. They should and 
generally do watch over her virtue, that she may be found a virgin 
by her husband. 

Marriage being consent, the daughter beforehand should be 
initiated into what she is about to undergo : that her husband may 
assume the right to constitute himself the judge of her past morals, 
virtue, and purity. 

Duty of the Husband. — The husband ought not to emulate 
ancient barbarism, under any circumstances, by beginning the union 
with distrust, by debasing or humiliating a poor, innocent girl. 
When she has had a misfortune, even a weakness, he may be sure 
that she will love him who rescues and adopts her, instead of the 
ingrate who deceived and outraged her. How would it be if she 
should inquire about the previous morals of her husband ? Her 
whom he esteems sufficiently to confide to her his future life, he 
ought to place confident in at once and for all past time. " He 
takes her for better or worse." 

Have pity on her ! Be kind and gentle to her ! Appreciate her 
situation ; care for her , re-assure her. Let her know that you are 
not her enemy ; on the contrary, a most devoted friend, entirely at 
her service. Be discreet, full of tact, understanding and respecting 
her situation. Encourage her to the utmost. Tell her this: — "I 
am thine. I am a part of thee. Take me as thy mother and thy 
nurse. Confide wholly in me. Thou art my wife and my child 
also." 



LOVE AND MARRIAGE. 413 

Create your Wife. — The girl or young spouse, after being 
born again (into the kingdom of love), desires nothing better than 
to be taught and remodelled by her lover or husband. She adopts 
his creed and people, confiding her body and soul to him. She 
believes in him. He should therefore endeavor to separate her from 
all evils surrounding her, from any faults of education or association 
she may have ; in a word, re-make, re-create her. " Love loves 
more what it makes. 11 

Just before or after the time of the monthly crisis (if not too 
painfully near), is the time to be chosen to make lasting impressions 
upon her. This profound renewing which she suffers with so much 
pain, makes her the gentlest and most pliable of beings. "As 
soon as you love her, envelope her, isolate her from bad influences. 
Every folly of woman is born of the stupidity of man." 

Love, a Necessity in Woman. — Woman cannot live without 
man. It has been truly said, that all her ailments proceed, either 
directly or indirectly, from ihe womb, the organ of love and ma- 
ternity. What causes her headache, colic, etc.? Not being loved 
enough. It is different with man : excepting climate, his maladies 
proceed mostly from the digestive organs. He eats and drinks too 
much, carrying invigoration to excess. 

Confide in Each Other. — As in matters of business, also in 
matters of the heart, the wife and husband should cousult and 
confide in each other ; should deliver up their last secret, by telling 
each other every thing. 

A wife is a fortune, especially whon she is poor. Then, though 
she has nothing, she brings you every thing. If you wish to ruin 
yourself, marry a rich wife. 

She Loves but One. — Woman is the mortal enemy of 
polygamy. She wishes for the love of one only, and to give 
herself to one alone — her husband — and belong to him forever. 

At all times, when fatigued and having exhausted or lost his 

mental vigor, man takes in a new supply from woman, from her 

soothing presence, her chaste bosom. In his dark moments, when 

he is in trouble and seeks in vain his star in the heavens, he looks 

toward woman, and, behold! his star is in her eves. 
19 



414 LOVE AND MARRIAGE. 

Love, not in a Crowd. — What influence can you have over a 
woman in society ? None at all ; in solitude, every influence. 

" Do not sow seed by the wayside ; 
Do not plant trees in the torrent ; 
Do not love amid the crowded haunts of men." 

A Poor Worker. — Woman, so often interrupted by sickness, 
is a very bad worker; particularly, during the week of the menses 
and the period when she is enciente, is she an invalid. It is the 
paradise of marriage, that the man shall work for the woman; 
spare her the hardships of labor and rude contact with the world. 



Time of Conception. — After long investigation, it has been 
proven by science, that conception only takes place at the time of 
the menses ; that is to say, near the time when the discharge an- 
nounces the appearance of the ovum, or ova — a little after, or a 
little before. Hence, there is barrenness during a part of the 
month. 

Time of Marriage. — During the week of the sanguinous 
crisis, for obvious reasons, marriage should not take place. Dur- 
ing this period of relaxation, languor, and it may be suffering, 
nothing should be done to unduly excite a mind already confused 
and terrified as if by an approaching tempest. 

Nobility of Love. — Love in woman is an exalted and noble 
thing. She stakes her life upon it. 

Love creates love, and augments it. The secret of loving each 
much is, to occupy ourselves much one with the other ; to live much 
together. 

Every time woman consents and yields to man's desire, she 
testifies her willingness to die for him. 

Effect of Variety. — Man, wearied, bewildered, palled, and 
disgusted with the mania for variety and hurly-burly of life, which 
robs him of all his strength, takes cowardly refuge in a different but 
more fatal enervation; in a dull narcotism; in vague and barren 
dreams ; the fumes of tobacco : the stupefaction of alcohol. But 
he who lives according to reaso , will understand that woman con- 



LOTE AND MARRIAGE. 415 

stitutes the best narcotic and the best stimulant. The two alter- 
nated intoxications, the two opposed deliriums, which bestow bal- 
ance of reason, are found healthful and vivifying in the breast of 
woman rather than in ail this false life. 

The TTife Renews the Max. — The wife is a true sister to the 
man in the labors of life : more than sister and more than wife to 
console him. and to rest his weary head at night. She comforts his 
fatigue — a nurse ; she lulls him to sleep, and. taking him again into 
her bosom, brings him forth with renewed life, forgetful of all things, 
and rejuvenated for the joyous waking of the morn. Such is the 
power of marriage, but not of transient pleasure. The longer it 
lasts, the more is the wife a mother to the husband: the more 
her sou. It is their guaranty of immortality. United thus, who 
shall disunite them ? 



Adultery of the Woman. — Are the adultery of the woman 
and the adultery of the man equally guilty \ Yes. as an infidelity, 
a violation of vows. Xo, in a thousand other resj : 

Fearful Consequences. — This treachery of the woman car- 
ries with it fearful consequences : that of the man does nor. The 
woman does not simply betray her husband; sb.€ up his 

honor and his life. She makes him gossipped about, ridi 
pointed at, hissed. She puts him in peril of death: of eithei 
ing a man. or remaining a butt: it is almost as though she let an 
assassin into the bouse by night. 

He will Buffer a moral assassination all the rest of his life : never 
knowing whether her child i» his child, obliged to rear and provide 
for a doubtful progeny, or to amuse the public by a trial which, 
wbeth. r he gains or loses, makes his name a by-word and a jest. 

Responsibility of Woman. — It is folly to say that the woman 
has no more responsibility than the man. He. by his activit 
strength, supports the family: but she is its heart. She alone knows 
its mysteries : she alone holds the secret of domestic happiness, the 
whole assurance for the future; she alone can attest a legitimate 
inheritance. A wife's falsehood may falsify history for a the 
years. 

What is the bosom of woman, if not our living temple, our sanct- 
uary, our shrine, where burns the light of God forever, where we 
each day are re-created ? If she delivers this up to the enemy: if 
she permit^ this lire, which is her husband's life, to be stolen, it is 
more dreadful than to plunge a knife into his heart. 

No punishment could be severe enough, if she knew what she had 
done : but she is, nearly always, very far from ever dreaming of 



416 HEREDITARY TRANSMISSIONS. 

CHAPTER III. 

i 

PARENTAGE — HEREDITARY TRANSMISSIONS. 

Heroes Born op the Most Elevated Love. — Woe unto the 
children of darkness, the sons of drunkenness, who were, nine 
months before their birth, an outrage on their mothers. 

He who is born of a nocturnal orgy, of the very forgetfulness of 
love, of a profanation of the beloved one, will drag out a sad and 
troubled life. 

On the contrary, it is a sublime, a mighty blessing to be conceived 
in the light; when a man's love is directed not to the sex indiscrim- 
inately, not to any woman whatsoever, but to this single woman; 
to this heart which belongs to him, sajing, u She, and no other;" 
when it is mirrored in her smile, in her beautiful, quiet eyes, which 
reflect the dawn on him ; in her charming surprise and her artless 
impulse, which say, " Yes, yes ; I was dreaming of you." 

The profound and perfect harmony of the heart, the exquisite 
sense that love, in its most obscured moments and in its hidden 
light, preserves of the loved object, is that which produces divine 
fruit — a son of liberty and of light. Both are desirous. It is, 
doubtless, of the most elevated voluntary love that heroes have 
been born. — Michelet. , 



Union of Opposite Elements. — It has generally been pro- 
mulgated, in modern times, that persons should marry their oppo- 
sites in order to produce a superior progeny; that the qualities, 
physical and mental, should be crossed. There is, doubtless, more 
attraction in individuals between opposite or contrary qualities of 
body and mind. 

This is true, also, to a certain extent, with races, the most ener- 
getic of which have sprung from opposite or seemingly opposite 
elements. According to a recent French author, the blending of 
the white man with the black woman produces a race of extraordi- 
nary vigor. " Such is the virtue of black blood," says he, " that 
wherever a drop of it falls, everything revives. No more old age — 
a young and puissant energy; it is the very fountain of youth." 
See pages 387-393. 



Union of the Same Elements. — However plausible the doc- 
trine of crossing the races may have been, it is now pretty certainly 



HEREDITARY TRANSMISSIONS. 417 

settled, that the highest degree of vigor may be attained by a con- 
centration of the energetic races. It is proven, that the blood of all 
races cannot be blended with impunity; a degradation follows. 
There must be a strong sympathy, in order to be successful, though 
seemingly opposed. - The progeny of the strong and perfect, result- 
ing from a union with the weak and inferior, will be but of an 
ordinary quality; while that resulting from a' union of strength and 
perfection on both sides, will be a concentration of vigor and genius. 
This principle is understood and practised in breeding and rear- 
ing horses and other animals. The famous race-horse Eclipse was 
produced by a successive union cf the accumulated blood of a pure 
race, unimpared by combining. 



Marriage of Relatives. — In regard to the marriage of rel- 
atives, it has been said, that if wedded love be added to the love of 
kindred, there will be too much love. But the contrary is seen among 
the Hebrews, who, notwithstanding being allowed to marry their 
cousins, and sisters even, were seen running after the daughters of 
the Philistines. The Greeks married their half-sisters until thi3 
custom was abolished by the laws of Solon. This race was regarded 
as the most beautiful in the world, though not very productive. But 
Greece looked only for heroes, not numbers, which, in a short time, 
exhausted the race by too great a concentration. The Romans 
married no closer than their cousins. 

Much has been written of late upon the subject of marriage be- 
tween relatives; and we are forced to the conclusion, not only from 
experience of the ancients, but also from our own times, that such 
unions are productive of strength in the progeny of the strong; 
while that of the weak will further degenerate. Care should be 
taken that the same disease or morbid tendency do not exist in both 
husband and wife. 



Crossing of Qualities. — As : ' like produces like," it is obvious 
that persons of extreme characteristics should not seek to further 
accumulate and enhance such personal qualities in their offspring. 
For instance, the tall should marry the short ; the corpulent, the 
lean; the passionate, the gentle; the studious and gloomy, the 



418 HEREDITARY TRANSMISSIONS. 

sprightly ; the timid, the brave ; the weak, the strong, and so on ; 
and the extremes in the parents will be corrected in their offspring. 
By the same rule, the fair-complexioned and red-haired should seek 
to marry brunettes. 

It is a- known fact, that "like love not their like" so well as 
something different. Still, the dispositions of married people must 
assimilate in some particulars. The sanguine and warm-natured 
ought not to be united with the cold and phlegmatic, or there is 
danger that the continued soft caresses of love might excite disgust. 
So, in marrying opposites, the nature and disposition must be such 
as to divert and excite, not shun each other 

This crossing of the most prominent qualities in partners is an 
admirable arrangement, establishing, as it does, an equilibrium, and 
preventing extremes; for the union of dwarfs produces dwarfs, and 
the union of giants produces giants. Also the children of parents 
alike irritable, alike lymphatic, alike diffident, etc., inherit the con- 
centrated qualities of both to such an extent as to become seriously 
disagreeable. 

The uniting and blending, however, of all races in one universal 
marriage, a beautiful dream of love, were it possible, would prob- 
ably result in a certain colorless, faded element, fatal to love itself. 



The Husband's Duty. — The wife should not be made the 
passive means cf pleasure to the husband. Unless shared in by 
her, there should be none for him. The selfish impatience of the 
man, desiring only self gratification, excites and irritates her only 
to be disappointed. Can the man be satisfied with the brief pleas- 
ure taken by force from cold marble? The children of such a 
marriage are to be pitied. Marriage exists only in the interchange 
of sentiments of the heart and those mutual, salutary raptures 
which console and renew life. 



Period of Barrenness. — Woman should never be impreg- 
nated without her consent. It is for her to say, if feeble, or ill, or 
badly formed, whether she will accept that risk of death. At her 
request, the husband should refrain, especially at the time of the 



HEREDITARY TRANSMISSIONS. 419 

development of the ovum (during menstruation and the week 
following). Is she sterile during the intermediate period? She 
ought to be, up to within a few days of the menses, as the ovum is 
wanting, though it may be produced or developed by passion. 

Fecundation Extends long into the Future. — Impreg- 
nation in woman transforms her in a lasting manner. The widow 
frequently bears to her second husband children resembling the first. 

It is the same with animals. The bee is impregnated for a year; 
the hen, for her whole brood ; and most insects, for several genera- 
tions. The mare once impregnated by an ass, ever after presents 
nothing but asses, or, at best, colts of an awkward appearance, thus 
betraying the inferiority of the first love. 

This law among animals, which devotes the female to her first 
love, seems to be the same in the human species. The first love 
and the first child appear to extend to those of the future; tlie 
father of that child extending his paternity to those which the 
woman may have by a second husband or by a lover! 

In former times, it was observed that adulterous women had 
children resembling the husband. Hence, the adage that " The son 
of adultery pleads for his mother." It has' also been seen that 
widows, impregnated during their first marriage, have afterwards 
had children by a second and dearly beloved husband, resembling 
the first husband, long dead and but little regretted. Here, neither 
fear nor love had any influence. . 

" If it were always thus, if the first impregnation infallibly 
modified the woman forever, adultery would be impossible (at least 
in its results). The possession of the husband being unalterable, 
the only one deceived would be the lover." 



Hereditary Tendency to Disease. — In addition to our own 
diseases, which may be said to be accidental, we frequently have to 
cope with those which we get from our ancestors, which lie awaiting 
the day of our weakness. The purest, the most virtuous, and the 
most beautiful, may none the less possess a germ in her blood 
which may, ere long, develop itself. 

As we often resemble our parents in external forms, says Dr. 



420 HEREDITARY TRANSMISSIONS. 

"Wood, so also do we inherit their internal peculiarities, and conse- 
quently all the morbid tendencies growing out of them. It is not 
diseases, \ generally speaking, that are inherited ; it is only the 
peculiarity of structure or constitution which serve as predispo- 
sitions to disease. We are not born with the scrofula, gout, 
rheumatism, 6tc, of our parents, but only with that condition of 
system which favors the development of those affections when 
•other causes operate. The inherited diathesis, however, is often 
efficiently strong to lead ultimately to the disease without other 
cause. We see this fact constantly illustrated in consumption and 
gout. Nay, the hereditary disease will often be developed, notwith- 
standing the most determined measures to prevent it which sagacity 
and experience can suggest. 

The inheritance may descend from either parent, or both. It has 
been supposed, that the peculiar diseases of the mother are more 
apt to be found in the son, and those of the father in the daughter; 
but the accuracy of the opinion may be doubted. When only one 
parent is affected, it often happens that the offspring escape en- 
tirely, taking after the healthy parent exclusively; but when both 
are diseased, and in the same way, the chances of escape on the 
part of the children are greatly diminished. Hence the danger of 
constant intermarriages between near connections, who may be sup- 
posed to have the same defects of constitution. The morbid ten- 
dencies thus go on, accumulating from generation to generation, 
until families, and even races, become extinct. Sometimes the 
hereditary malady passes over one generation, to fix upon the 
next. The child escapes, but the grandchild is affected. This 
fact admits of easy explanation. It is only the tendency that is 
received from the parents. This may remain latent from the ab- 
sence of causes calculated to call it into action ; or, counteracting 
circumstances may exist, which shall prevent its development. 
The tendency is, nevertheless, handed down to the next gener- 
ation, which may be less fortunate in relation to the influences 
that bear upon it. 

Occasionally we observe family predispositions to disease which 
have no prototype in the immediate or even remote ancestors. One 
child after another falls a victim to the same disease, from some 



HEREDITARY TRANSMISSIONS. 421 

inherent vice of constitution ; and parents themselves of sound 
health may thus be completely stripped of their offspring. This 
sometimes happens from a vicious system of physical education 
and is much more frequent among the rich than the poor. But in 
other instances, the defect is received from the parent, and exists 
from birth. In such cases, however, the disease cannot, in strict- 
ness, be said to be hereditary. 

Complaints dependent upon inherited peculiarities of system are 
apt to appear earlier in life than similar complaints of a different 
origin. The most common hereditary diseases are scrofula or con- 
sumption, cancer, rheumatism, or gout, and insanity. Although 
none of these diseases are always hereditary, being also produced by 
other causes, still it is known, that by far the greater percentage are 
of that class. Dyspepsia and many other chronic diseases are also 
often hereditary in character. 

Venereal Diseases are often the primary cause of hereditary 
tendency to disease. They may be ranked as among the most ter- 
rible curses of the human race, and arise from inoculation, gener- 
ally intercourse with a diseased person. They are of two kinds, 
syphilis and gonorrhoea, the former of which is by far the most 
fatal. A few days after coition, a slight pimple forms, accompa- 
nied by itching, followed by an ulcer, called a chancre. When 
properly treated, these sores are immediately destroyed by the 
application of caustic, or there is danger of extensive erosion and 
destruction of the parts affected. There are also swellings in the 
groins, forming buboes. After a few months, secondary symptoms set 
in, and there are ulcerations of the mouth and throat, and scaly 
eruptions on the skin in various parts, culminating sometimes in 
the destruction, not only of the organs of generation, but of the 
nose and mouth. In other cases, even when the disease seems to 
have been cured, after the lapse frequently of many years, it 
re-appears, acting with great violence upon various parts, extending 
even to the bones. Health, beauty, and life itself, are frequently 
destroyed by this terrible malady, contracted mostly by the young 
in a thoughtless moment, for the want of a little timely knowledge 
and advice. 



422 HEREDITARY TRANSMISSIONS. 

Syphilis is Transmissible from the parent to the child. It 
may be inherited from one or both parents. It is very common for 
a man, who does not himself display a single symptom of any kind, 
and who appears to be in perfect health, to beget a syphilitic child. 
— Hutchinson. In all stages of constitutional syphilis, the taint may 
be transmitted to the child, the degree of severity depending upon 
the period which has elapsed since the presence of active symp- 
toms. Syphilis may affect the foetus at an early period, and is the 
cause of miscarriage in the mother ; or, in case the child lives, it 
may be imperfectly organized; and, in consequence, may result 
diseases of the lungs, liver, kidneys, and other organs, too numerous 
to mention. 

Consumption, etc., Transmitted. — That the tuberculous 
constitution is transmitted from parent to child has long been a 
popular belief, and regarded as fully established. 

Parents whose digestive organs are habitually disordered, who 
suffer from gout, the injurious influences of metallic and other 
poisons, such as mercury, malaria, syphilis, chlorosis, or the debility 
of advanced age, so that a cachectic state is induced, entail upon 
offspring begotten during such morbid states of the parents to an 
extent still undetermined, but obvious and appreciable ; a tendency 
to the tuberculous constitution not necessarily to be expressed by 
the growth of tubercle in the lungs, but certainly and surely by 
various forms of dyspepsia, and a precarious state of health. — 
Aitlcen. Or, similar causes may also produce cancer, insanity, etc. 

A disordered state of the health of the mother, resulting from 
disease, or unhealthy mode of life, depressing passion, etc., influ- 
ence the state of the child in utero to a great extent. There are 
many other causes, such as debility, resulting from impure air, 
improper quantity and quality of food, etc., etc. So long as pov- 
erty and misery exist on the one hand, or dissipation and enervating, 
luxuries on the other, so long will the causes be in operation which 
induce numerous diseases. 



Influences before Birth. — It is certain, that nature de- 
signed that the race should be perpetuated and perfected here. And 



HEREDITARY TRANSMISSIONS. 4'23 

to this end exists the sexual clement in man and woman, impelling 
them to comply with the requirements of their being. In repro- 
duction it is necessary that the affections and moral powers should 
take a prominent part. In case animal instinct only is concerned, 
the result must be a progeny morally inferior. 

The period of utero gestation is an important one for the child. 
It is at this time that it is constituted for good or evil. It then 
receives the elements of character, of body and soul, and natural 
tendencies, which, in a measure, guide it afterwards, when it enters 
upon its independent existence. 

Children often struggle into existence against the wishes of their 
parents. "When the soul of the mother rebels against the existence 
of the new life within her, and does not hesitate to use every means 
to destroy it, to prevent the development of her child instead of 
promoting it, what must necessarily be the character and disposi- 
tion of that child ? Is it a wonder that such a child lives to curse 
the day of its birth, and those unnatural parents who gave it being ? 
"What a state of society is that which prompts woman to hate her 
unborn babe, and to seek its destruction ! Most unnatural and 
brutal, though called Christian and civilized. 

The Child of Love. — Love should watch over the child prev- 
ious to its birth and afterwards. Its every stage of development, 
from the first to the last, should be hailed with joy, hope, and faith. 

How infinitely is a love origin to be desired ! How above all 
price is a love ancestry! Talk not of an ancestry of princely title; 
of knightly deeds in war and slaughter: talk not of a parentage of 
wealth, of station and dignity, in church or state. More to be 
valued is a lineage of love than an ancestry of untuld wealth, or of 
the most honorable titles and standing. This love lineage is a 
foundation on which the soul may build for eternity. — Wright. 

Retain the Sexual Element. — The husband has no right 
to demand sensual intercourse with the wife unless acquiesced in by 
her, and never under the following circumstances : during the san- 
guineous discharge; during gestation and lactation; and never unless 
the pleasure is reciprocated by each, with a desire for children. 



424 HEREDITARY TRANSMISSIONS. 

Retain, then, the sexual element, and expend it only for offspring. 
This is the voice of reason. When so retained, it conduces to ihe 
health, beauty, strength, and activity of the body and mind ; to the 
nobleness and energy of the soul; to the refinement and social 
enjoyment of home ; and to the progress of the human race. 

Conduct of the Parents. — Whatever circumstances or dis- 
eases affect the parents must also affect their germs, as being a 
portion of their systems. Consequently each, the father and mother, 
impresses upon the child its own peculiar conditions of body and 
soul, whether disease and deformity, or health and beauty. A great 
obligation, then, rests upon parents, to see, so far as they can, that 
everything is done to give perfection of existence or organization to 
their future progeny. For some time previous to blending the two 
elements in which the child is to originate, parents should abstain 
as much as possible from artificial stimulants ; adopt a simple diet, 
keeping aloof from all occasions and scenes calculated to produce 
unusual excitement of the mind, and, by calmness, endeavor to call 
into activity the most ennobling elements of their nature. Let 
perfection of offspring be the ruling motive, instead of sensual 
gratification. 

The woman, after receiving into herself the life-germ of a new 
being, should forego all practices and indulgencies which conflict 
with her own health and the perfection of the child. During the 
period of pregnancy, let the wife be surrounded with tender care 
and happy influences. Let her avoid stimulants; adopt a plain 
diet; avoid excessive toil and fatigue; and be kept from depressing 
gloom, anxieties, and irritations. Above all should she abstain 
from all arousing of the sexual instinct and carnal intercourse with 
her husband. 

Acquired Diseases Transmitted. — Bad conditions in the 
parents are as likely to be transmitted to children as good tenden- 
cies. We have already spoken of the many diseases capable of 
being transmitted, and alluded to acquired tastes and tendencies 
which are also transmissible. Some, whose organizations were 
originally quite sound, acquire diseased conditions by unnatural 



HEREDITARY TRANSMISSIONS. 425 

indulgence and practices. Prominent among these causes, besides 
sexual abuse, are the use of alcoholic spirits, opium, and the ex- 
cessive use of tea and coffee; and, last, but not least, miscarriage 
or abortion, often criminally produced, though not without carrying 
a long train of evils to the suffering victim. 

Drunkenness. — A woman of wealth and fashion, naturally 
healthy, became addicted to strong drink, and exceeding passionate. 
She had four children. They were all either deformed, deaf and 
dumb, or diseased, and died early of consumption. One was a 
demon of temper and a drunkard. 

In another case, the wife was healthy, accomplished, and beauti- 
ful. Her husband became a sot, and when drunk, sought and 
obtained intercourse with his wife. An idiotic child was the result. 

Sexual Abuse. — A man and woman, both healthy at marriage, 
afterwards, by abuse of their sexual nature, became debilitated and 
diseased. They had five births; the first, an abortion produced by 
sexual abuse during pregnancy. The living children were all 
diseased at birth, and died young of scrofula and consumption. 

Solitary Sexual Abuse. — Unfortunate is the woman and 
her children, who marries a man addicted to this vice. If he was 
unable to control his passion before marriage, he will not do it 
afterwards. Before, he only ruined himself: now, he implicates 
also a wife, and brings into the world a weak and suffering progeny. 

A young man, by self-abuse from childhood, wore out his vital 
powers of body and mind at the age of twenty-one. His memory 
left him ; he became incapable of studying, and lost all relish for 
society and the world. In accordance with the advice of friends, he 
married. The result was an idiotic, imbecile child. The father 
paid the penalty of his outraged nature by a short, miserable life 
by dying early with consumption. 

A young girl at school early acquired the habit of solitary abuse. 
Her spiritual life left her; her digestion became impaired, and the 
period of puberty was not announced by the usual developments 
of the breasts, etc. Still she was tormented with an insatiable 



426 HEREDITARY TRANSMISSIONS. 

sensuality, which could not be appeased. She married, but, receiv« 
ing little pleasure from the usual marital relation, resorted yet to 
artificial abuse as a means to appease her unnatural desires, until 
complete exhaustion, insanity, and death, terminated her useless 
life. There was no conception in her case. 

Sexual Abuse During Pregnancy. — A man and his wife, 
when married, possessed vigorous constitutions. The husband 
gave himself up to an unnatural passion, and insisted upon con- 
nection with his wife very frequently during pregnancy. He often 
forced her to yield, regardless of her tears and entreaties to spare 
her for her child's sake. The child was born, but lived only a few 
weeks. There was another conception, followed, in this instance, 
by an abortion produced by the husband's insisting on his legal 
right. Within a week after this event, he still insisted upon sexual 
intercourse with his wife. The man and wife both afterwards died 
of consumption; he, the victim of passion, and she, the victim of 
his lust, under the sanction of law and religion in a civilized (?) 
country ! 

Effects of Abortion. — A young lady, in an unguarded mo- 
ment, yielded to the embraces of her lover, and conception followed. 
Instead of their marrying, she thought to avoid dishonor by pro- 
curing abortion. This was successfully accomplished by an 
abortion doctor, though not without great injury to the health of the 
lady She afterwards married the same lover. Several conceptions 
were followed by miscarriage as often, at the same period as the 
first one was produced, until the lady finally succumbed to debility, 
and died. 

In another case, a married lady, who had successfully given birth 
to four children, destroyed the fifth conception. This she again 
repeated, destroying the sixth. She then conceived again, but 
could not succeed this time in procuring abortion. The child was 
born fearfully diseased, and lived but four months. Shortly after, 
the mother died also, the victim of self-abuse and violence. 

Mental Conditions During Pregnancy. — Medical books 
abound in facts showing that the physiological as well as the psy- 



HEREDITARY TRANSMISSIONS. 427 

etiological conditions of the mother during pregnancy, may and do 
affect the child, producing deformities, such as marks on the skin, 
absence of a limb, etc. To avoid such dangers, women should be 
educated to habits of calmness and presence of mind under sudden 
emotions and in the presence of exciting scenes and deformed 
objects. The development and happiness for life of her unborn 
babe may depend upon her calmness and self-possession. Anxiety, 
terror, or emotion, prolonged for some time, is likely to prove more 
injurious than a sudden impression. 

Effects of Lactation. — It is fully established, that nursing 
infants are affected by the physical and mental condition of the 
mother during lactation, and often exposed to suffering, and even 
death, by some great terror or emotion of the parent. No secretion 
so evidently exhibits the influence of the emotions of the mind 
as that of the breasts; which is, doubtless, owing partly to the fact 
of the delicate digestive system of the infant. 

Alcoholic Spirits, as well as strong tea and coffee immod- 
erately used during nursing, have been known to cause great rest- 
lessness and suffering in the child, and are thought to impress 
permanent excitability and derangement upon its nervous system. 

Effect of Anger and Terror. — Children have frequently 
been thrown into convulsions, after having been nursed by mothers 
while excited by an ungovernable anger. A child in the most per- 
fect health has been known to die upon its maternal bosom while 
being nursed, after the mother's experiencing great fear and terror. 
Also, an infant has been known to die in a convulsion, in conse- 
quence of being nursed by a mother after hearing of the death of a 
dear friend. 

Tranquillity Required. — The secretion of milk proceeds 
best in a tranquil state of mind and cheerful temper; then it is 
abundant, and agrees well with the child. A fretful temper lessens 
the quantity of milk, and causes it to produce fever and griping in 
the child. Anger has a similar, though still greater effect. Grief 



428 HEREDITARY TRANSMISSIONS. 

anxiety of mind, as well as fear and terror, — all, as before remarked, 
have a powerful influence. 

Substitutes. — Taking in view all these circumstances, infants 
often should not be nursed at all by their mothers, but by another 
woman of placid temper; or, other aid may be necessary for the 
nourishment of the child. This is also often necessary in conse- 
quence of ill-health or diseased conditions in the mother. 

We should also remark, that those passions which are generally 
sources of pleasure, when carried to excess, alter and even entirely 
check the secretion of the mammae, or breasts. Also, a diet dis- 
agreeing with the mother is known to disagree with the child. 

Important Facts. — Let all deeply ponder upon the foregoing 
facts. It is certain that the conditions of the parents, particularly 
those of the mother before and during gestation and lactation, have 
a lasting effect upon the welfare and happiness of their children, 
as well as themselves and their homes, forever. Let the mother, 
then, be guarded from all unnatural excitements and unhappy 
emotions Let her condition be one of sweet serenity, and holy 
love and reverence for the new life which is being developed within 
her own. 

The True Physician. — Disease is an effect, not a cause; an 
evil to be prevented. Physicians are designed to minister also to 
the spiritual principle. They should be clergymen, or clergymen 
should be physicians. Their pursuits should be essentially prophy- 
lactic. They must banish consumption, scrofula, erysipelas, rheu- 
matism, contagious diseases, and every species of individual afflic- 
tion, by commencing at their foundation. They must ascend the 
pulpit, and teach the inhabitants of the earth concerning hereditary 
impressions ; explain how parents influence their children while in 
the embryotic state ; explain how the human mind and body are 
under the control of surrounding circumstances ; how the entire 
individual can be manufactured perfect or imperfect; how the spir- 
itual principle acts upon the organization. They must teach the 
philosophies of anatomy, of physiology, of chemistry, of median- 



HEREDITARY TRANSMISSIONS. 429 

isin, of electricity, of magnetism, and of psychology. If clergy- 
men will not teach these fundamental truths of nature, and of true 
religion : if they combine their intellectual and pecuniary powers 
against the promulgation of these principles on the Sabbath ; if 
they clamor about desecrating the holy institutions of antiquity, — 
then congregations must arise in their strength and demand the 
true physician. 

The true physician places his band upon moral as well as upon 
physical disease. He cures the maladies of future generations by 
closing the floodgates of individual excesses ; he manufactures good 
and healthy organizations by improving and perfecting the indi- 
viduals by whom future generations are developed. This is the 
mission of the true physician. — A. J. Davis. 
19* 



DIETETIC PREPARATIONS 

AND ADDITIONAL FORMS OF PRESCRIPTIONS. 



Barley water. — Wash clean some pearl barley, and to two ounces of 
barley add one quart of water. Add a few raisins, or some lemon peel 
aad sugar, and boil slowly till reduced one half. Then strain and sweeten. 
As nourishment in inflammatory diseases- 

Rice water. — Wash well two ounces of rice, and add two quarts of 
water. Boil for an hour and a half, and then add sugar and nutmeg to 
liking. This, mixed with milk, forms an excellent diet for children. 

Vegetable soup. — Take one potato, one turnip, and one onion, with 
a little celery. Shce, and boil in one quart of water for an hour ; add 
as much salt as is agreeable, and pour the whole upon a piece of dry 
toast. To be used when animal food would be improper. 

Panada. — This may be made by boiling some slices of soft bread 
for five minutes in a quart of water ; then beat the bread smooth and 
mix with it a little of the water, a bit of fresh butter, and sugar and 
nutmeg, according to circumstances. Or, it may be made by grating 
some bread or pounding a few crackers; then pour on boiling water, 
beat it well, and add sugar and nutmeg or cinnamon. 

Indian gruel. — Pat three large table-spoonsful of Indian meal, sifted, 
in a quart of water; wash with several waters, turning them off as the 
meal settles ; boil for twenty minutes, stirring all the while : then add a 
little salt. It may be strained, sweetened, a little butter added, wine or 
nutmeg, according to circumstances. Oat meal, and other kinds of 
giuel may be prepared in the same manner. 

Mutton, chicken, veal and beef broth. — To one pound of either of 
these, lean, allow one quart of water; add a little salt, parsley, or an 
onion, and put in large pieces of the crust of bread. Boil slowly, and 
skim for two or three hours* Barley, rice, etc., may be added, if expe- 
dient. Broth may be made more speedily by slicing and pounding tlifl 
meat ; it is, also, made more palatable by first broilivg it. 

Beef and chicken tea. — Cut into shreds one pound of lean beef, or 
take quaner of a chicken with all the fat striped off and bones broken ; 

431 



432 ADDITIONAL FORMS OF PRESCRIPTIONS. 

boil for twenty minutes, skimming, and add a little salt. The former is 
very nourishing. 

Tapioca, arrowroot and sago, are prepared by washing thoroughly, 
and then boiling sufficiently; then a little wine, nutmeg, or milk maybe 
added according to the fancy and circumstances. 

Wine whey. — To a pint of milk, while boiling, add a large wine-glass 
of Sherry or Maderia wine ; after it again boils, remove it from the fiie 
and let stand a few minutes. Then remove the curd, pour the whey 
into a bowl, and sweeten it. 

Calves" feet jelly. — Totwo calves' feet add one gallon of water, and 
reduce bT boiling to a quart; strain, and >vhen cold, skim. Add the 
whites of six or eight eggs well beaten, a pint of wine, half a pound of 
loaf sugai , and the juice of four lemons — all to be well mixed. Now, 
boil thev hole for a few minutes, stirring constantly, and strain through 
flannel. The wine, when objectionable, should be omitted. 

Tapio* a, sago, and rice jelly. — These are made by taking a proper 
quantity >f any one of them, washing and soaking in water sufficiently; 
then boil gently till they form a glutinous mass, and add lemon juice and 
peel, wine, sugar, and cinnamon ; or, season according to fancy. Arrow 
root and bread jelly are made in much the same manner 



ADDITIONAL FORMS OF PRESCRIPTIONS. 

PURGING ENEMA. Soft Soap one ounce, 

0.1 re Oil one ounce, Colocynth two scruples, 

EpsomSalts half do Water ■ one P int * 

g uo - ar 9 one <jo Useful in hysteria, colic and coii- 

Senna do do vulsions. 

Boiling Water sixteen do ENEMA OF OPIUM. 

Infuse the senna for an hour, dis- Laudanum „ . , . .thirty drops, 

so^ the sugar and salts and mix Decoction of Starch. . .four ounces, 

the oil by agitation. Useful as an anodyne. 

ALOETIC ENEMA. TURPENTINE ENEMA. 

Aloes .two scruples, Oil of Turpentine one ounec, 

Garb. Potash. . . .twenty-five grains, Eggs one, 

Decoction of Barley. . . .half a pint, Rub together, and add nineteen 

Mix and rub together. Useful in ounces of barley water or decoe- 

Amenorrhea. tion ot starch. 

ANTISPASMODIC ENEMA. TONIC PILLS. 

TWt Asafoetida two ounces, Ext. of Bark one ounce., 



ADDITIONAL FORMS OF PRESCRIPTIONS. 433 

Ext. of Gentian one ounce, pills. Dose — one eve^y two 01 

Sul. Iron half a drachm, four hours. Useful in uterine 

Pulv. Myrrh one do hemorrhage. 

Oil of Anise.. tea drops, C0P AIBA MIXTURE. 

& ^' Bal. Copaiba one ounce, 

Mix and make into sixty pills. , T ., ^ A ,. . , 

J r Mucilage G. Arabic. . . .two do 

Dose — three twice a day. o * t j j i, 

' opts. .Lavander. .... -two drachms, 

EMMENAGOGUE PILLS. Camphor Mixture five ounces. 

Sul. Iron one ounce, Mix— one or two table-spoonsful to 

Carb. Potash sixteen grains, ^ taken from two to four times a 

Myrrh one ounce, day in i nve terate leucorrhea and 

Pulv. Aloes half a drachm. chr0 nic menorrhagia. If borne 

Mix thoroughly, and make into by the st0 mach, an addition of 

thirty pills. Dose— three, once one or two drachms of the pow- 

or twice a day. Useful in sup- der f cubebs may be made. 

pression of the menses, where 

there is no counter indication. ASTRINGENT INJECTION. 

LAXATIVE PILLS. ^Oak-bark six ounce,, 

r. , . , , , - , u Pulv. Galls thirty grains, 

Pulv. Aloes half a drachm, _. ~ . * _ , 

_,, . _, . . , , Tinct. Catechu two drachms, 

Pulv. Rhubarb do do _ . . 

~ • . Powerfully astringent — in chrome 

Soap....... onescruple. f' m , ir 

■»«-• . . it _ , r leucorrhea. lo be used from one 

Mix, and with water form a mass, 

and divide into twenty pills. t0 three DmeS a ^ 

Dose — two or three at bed time or IODIDE OF IRON MIXTURE. 

before a meal. Useful in habitu- Iodide of Iron eighteen grains, 

al constipation. Tinct. Columba one ounce, 

ASTRINGENT PILLS. Distilled Water seven do 

Suffar T>ad twelve grains, Mix. Tonic. One or two table- 

Pulv. Opium one do Spoonsful to be taken two or three 

Gum Arabic and Syrup, of each a times a day. A piece of iron wire 

sufficient quantity to make six should be kept in the phial. 



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